Provider Demographics
NPI:1427681964
Name:TOLSMA STOCKWELL PROSTHETICS
Entity type:Organization
Organization Name:TOLSMA STOCKWELL PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:TOLSMA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:719-301-8198
Mailing Address - Street 1:384 E GARDEN OF THE GODS RD STE 140
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4243
Mailing Address - Country:US
Mailing Address - Phone:719-301-8198
Mailing Address - Fax:
Practice Address - Street 1:384 E GARDEN OF THE GODS RD STE 140
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4243
Practice Address - Country:US
Practice Address - Phone:719-301-8198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier