Provider Demographics
NPI:1902883473
Name:PROSTHETIC ORTHOTIC SPECIALISTS, INC
Entity type:Organization
Organization Name:PROSTHETIC ORTHOTIC SPECIALISTS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:505-244-0404
Mailing Address - Street 1:PO BOX 91630
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-1630
Mailing Address - Country:US
Mailing Address - Phone:505-244-0404
Mailing Address - Fax:505-244-0708
Practice Address - Street 1:5095 ELLISON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4326
Practice Address - Country:US
Practice Address - Phone:505-244-0404
Practice Address - Fax:505-244-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT6178Medicaid
NMT6178Medicaid