Provider Demographics
NPI:1942235445
Name:SPECTRUM ORTHOTICS & PROSTHETICS INC
Entity Type:Organization
Organization Name:SPECTRUM ORTHOTICS & PROSTHETICS INC
Other - Org Name:SPECTRUM ORTHOTICS & PROSTHETICS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FOREST
Authorized Official - Middle Name:
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:541-734-2435
Mailing Address - Street 1:3541 E BARNETT RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-734-2435
Mailing Address - Fax:541-734-4366
Practice Address - Street 1:3541 E BARNETT RD
Practice Address - Street 2:SUITE A
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-734-2435
Practice Address - Fax:541-734-4366
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHO DEV AMERICA CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-12
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR070263Medicaid
CAGXC00520OtherMEDICAL
OR058433000OtherBLUE CROSS BLUE SHIELD