Provider Demographics
NPI:1700888773
Name:SPECTRUM PROSTHETICS & ORTHOTICS
Entity Type:Organization
Organization Name:SPECTRUM PROSTHETICS & ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHWEIZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-243-1443
Mailing Address - Street 1:1349 NW 121ST ST
Mailing Address - Street 2:#300
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8145
Mailing Address - Country:US
Mailing Address - Phone:515-243-1443
Mailing Address - Fax:515-243-1443
Practice Address - Street 1:1300 DES MOINES ST STE 101
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-5547
Practice Address - Country:US
Practice Address - Phone:515-243-1443
Practice Address - Fax:515-243-5382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0284711Medicaid
IA33524OtherWELLMARK BCBS
IA0284711Medicaid