Healthcare Provider Details

I. General information

NPI: 1912903105
Provider Name (Legal Business Name): HIGH COUNTRY ORTHOTICS & PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S WASHINGTON ST.
CASPER WY
82601-2738
US

IV. Provider business mailing address

135 S WASHINGTON ST.
CASPER WY
82601-2738
US

V. Phone/Fax

Practice location:
  • Phone: 307-234-4214
  • Fax: 307-237-1228
Mailing address:
  • Phone: 307-234-4214
  • Fax: 307-237-1228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: HENRY ARTHUR OSBORNE
Title or Position: OWNER
Credential: CO
Phone: 307-234-4214