Provider Demographics
NPI:1043208812
Name:ORTHOTIC PROSTHETIC SOLUTIONS, LLC
Entity type:Organization
Organization Name:ORTHOTIC PROSTHETIC SOLUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-484-8388
Mailing Address - Street 1:1015 ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3926
Mailing Address - Country:US
Mailing Address - Phone:970-484-8388
Mailing Address - Fax:970-419-8870
Practice Address - Street 1:1015 ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3926
Practice Address - Country:US
Practice Address - Phone:970-484-8388
Practice Address - Fax:970-419-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250483-00Medicaid
KS200004560AMedicaid
OK200023800AMedicaid
IA0571356Medicaid
WY119226401Medicaid
NM79605061Medicaid
CO13631730Medicaid
CO4834710002Medicare ID - Type Unspecified