Provider Demographics
NPI:1205986403
Name:SPECTRUM PROSTHETICS LLC
Entity type:Organization
Organization Name:SPECTRUM PROSTHETICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:1963 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2040
Mailing Address - Country:US
Mailing Address - Phone:541-269-1773
Mailing Address - Fax:541-269-2790
Practice Address - Street 1:1963 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2040
Practice Address - Country:US
Practice Address - Phone:541-269-1773
Practice Address - Fax:541-269-2790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHO DEV AMERICA CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-11
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier