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General NPI Number Information
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NPI Number | 1205986403
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Entity Type | Organization
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Legal Business Name | SPECTRUM PROSTHETICS LLC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 1963 THOMPSON RD
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City | COOS BAY
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State | OR
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Zip | 97420-2040
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Country | US
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Telephone | 541-269-1773
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Fax | 541-269-2790
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Provider Business Mailing Address
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Address Line | 1963 THOMPSON RD
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City | COOS BAY
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State | OR
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Zip | 97420-2040
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Country | US
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Telephone | 541-269-1773
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Fax | 541-269-2790
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Authorized Official
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Title or Position | DIRECTOR
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Name | FOREST SEXTON
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Credential | CPO
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Telephone | 541-734-2435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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