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General NPI Number Information
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NPI Number | 1275140022
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Entity Type | Organization
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Legal Business Name | MOSAIC ORTHOTICS AND PROSTHETICS LLC
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 617 N 17TH ST # 102
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-3577
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Country | US
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Telephone | 719-271-5857
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Fax |
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Provider Business Mailing Address
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Address Line | 6305 MONTARBOR DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-4875
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CERTIFIED PROSTHETIST ORTHOTIST
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Name | JONATHAN MOORE
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Credential | CPO
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Telephone | 719-231-7893
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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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