Provider Demographics
NPI:1710233143
Name:ORTHOTIC PROSTHETIC SOLUTIONS, L.L.C.
Entity Type:Organization
Organization Name:ORTHOTIC PROSTHETIC SOLUTIONS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KRATOHVIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-8760
Mailing Address - Street 1:1015 ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3926
Mailing Address - Country:US
Mailing Address - Phone:970-484-8388
Mailing Address - Fax:
Practice Address - Street 1:1012 W 36TH ST STE 5
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-5008
Practice Address - Country:US
Practice Address - Phone:308-863-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOTIC PROSTHETIC SOLUTIONS, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-03
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13631730Medicaid