Provider Demographics
NPI:1588062764
Name:PROSTHETIC & ORTHOTIC GROUP PEDIATRIC SPECIALISTS - COLORADO LLC
Entity type:Organization
Organization Name:PROSTHETIC & ORTHOTIC GROUP PEDIATRIC SPECIALISTS - COLORADO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:MORRISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-588-6060
Mailing Address - Street 1:37 SHUMAN AVE
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3734
Mailing Address - Country:US
Mailing Address - Phone:508-638-1172
Mailing Address - Fax:508-588-7944
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:MAIL BOX B060
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:303-400-8866
Practice Address - Fax:970-416-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100265137-00Medicaid
NE100265137-00Medicaid