Healthcare Provider Details

I. General information

NPI: 1902883473
Provider Name (Legal Business Name): PROSTHETIC ORTHOTIC SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5095 ELLISON ST NE
ALBUQUERQUE NM
87109-4326
US

IV. Provider business mailing address

PO BOX 91630
ALBUQUERQUE NM
87199-1630
US

V. Phone/Fax

Practice location:
  • Phone: 505-244-0404
  • Fax: 505-244-0708
Mailing address:
  • Phone: 505-244-0404
  • Fax: 505-244-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNM

VIII. Authorized Official

Name: MR. JOE E LOTT II
Title or Position: PRESIDENT
Credential:
Phone: 505-244-0404