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General NPI Number Information
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NPI Number | 1407631310
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Entity Type | Organization
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Legal Business Name | COMPLETE PROSTHETICS & ORTHOTICS LLC
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Dates
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Enumeration Date | 08/29/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 9632 W EMERALD ST STE A
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City | BOISE
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State | ID
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Zip | 83704-9762
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Country | US
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Telephone | 208-609-6526
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Fax |
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Provider Business Mailing Address
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Address Line | 9632 W EMERALD ST STE A
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City | BOISE
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State | ID
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Zip | 83704-9762
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Country | US
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Telephone | 208-609-6526
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Fax |
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Authorized Official
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Title or Position | CLINIC ADMIN
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Name | JANENE MAUGHAN
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Credential |
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Telephone | 208-609-6526
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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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