Provider Demographics
NPI:1740739218
Name:ELITE PROSTHETICS
Entity Type:Organization
Organization Name:ELITE PROSTHETICS
Other - Org Name:CPOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:505-244-0404
Mailing Address - Street 1:5095 ELLISON ST NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4326
Mailing Address - Country:US
Mailing Address - Phone:505-550-5290
Mailing Address - Fax:505-244-0708
Practice Address - Street 1:5095 ELLISON ST NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4326
Practice Address - Country:US
Practice Address - Phone:505-550-5290
Practice Address - Fax:505-244-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier