Provider Demographics
NPI:1912903105
Name:HIGH COUNTRY ORTHOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:HIGH COUNTRY ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:307-234-4214
Mailing Address - Street 1:135 S WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2738
Mailing Address - Country:US
Mailing Address - Phone:307-234-4214
Mailing Address - Fax:307-237-1228
Practice Address - Street 1:135 S WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2738
Practice Address - Country:US
Practice Address - Phone:307-234-4214
Practice Address - Fax:307-237-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY312903OtherBLUECROSS BLUE SHIELD
WY119418600OtherMEDICAID DME
WY5012420001Medicare NSC
WY119418600OtherMEDICAID DME