Provider Demographics
NPI:1962578740
Name:INVIVO, INCORPORATED
Entity type:Organization
Organization Name:INVIVO, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHASEK
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:719-632-4275
Mailing Address - Street 1:2415 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1107
Mailing Address - Country:US
Mailing Address - Phone:719-632-4275
Mailing Address - Fax:719-471-0760
Practice Address - Street 1:2415 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1107
Practice Address - Country:US
Practice Address - Phone:719-632-4275
Practice Address - Fax:719-471-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08002982Medicaid
CO1052760001Medicare NSC