MEDICARE: NEW MEXICO PROSTHETIC-ORTHOTIC CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1881699031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MEXICO PROSTHETIC-ORTHOTIC CENTER, INC

Provider Business Mailing Address
First Line	:	2515 N KENTUCKY AVE
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-5807
Country	:	US
Telephone Number	:	505-623-0344
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 N KENTUCKY AVE
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-5807
Country	:	US
Telephone Number	:	505-623-0344
Fax Number	:

Authorized Official
Title or Position	:	OWNER-PRESIDENT
Name	:	ADAM DUTCHOVER
Credential	:	CPO
Telephone Number	:	505-623-0344

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	08/22/2020

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