Provider Demographics
NPI:1871665547
Name:HORIZON PROSTHETICS, LLC
Entity Type:Organization
Organization Name:HORIZON PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-660-1238
Mailing Address - Street 1:200 S WILCOX ST # 245
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1913
Mailing Address - Country:US
Mailing Address - Phone:719-266-0949
Mailing Address - Fax:719-266-0941
Practice Address - Street 1:1110 ELKTON DR STE E
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3555
Practice Address - Country:US
Practice Address - Phone:719-266-0949
Practice Address - Fax:719-266-0941
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCKENNA HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-15
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20156000418335E00000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20073089Medicaid
CO5942480001Medicare NSC