Provider Demographics
NPI:1558376913
Name:PROSTHETIC & ORTHOTIC SOLUTIONS, LLC.
Entity Type:Organization
Organization Name:PROSTHETIC & ORTHOTIC SOLUTIONS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:413-785-4047
Mailing Address - Street 1:66 MYRON ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1416
Mailing Address - Country:US
Mailing Address - Phone:413-785-4047
Mailing Address - Fax:413-785-4048
Practice Address - Street 1:66 MYRON ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1416
Practice Address - Country:US
Practice Address - Phone:413-785-4047
Practice Address - Fax:413-785-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X
MA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1529391OtherMASSHEALTH
MA5744340001Medicare NSC