Healthcare Provider Details

I. General information

NPI: 1154606499
Provider Name (Legal Business Name): COLORADO ORTHOTIC & PROSTHETIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 LUTHERAN PKWY STE 205
WHEAT RIDGE CO
80033-6017
US

IV. Provider business mailing address

8111 E LOWRY BLVD STE 220
DENVER CO
80230-7255
US

V. Phone/Fax

Practice location:
  • Phone: 303-456-6051
  • Fax: 303-456-6052
Mailing address:
  • Phone: 720-858-1111
  • Fax: 720-858-7052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID MICHAEL NALDER
Title or Position: PARTNER
Credential: CPO
Phone: 720-858-1111