MEDICARE: SPECTRUM PROSTHETICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1205986403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM PROSTHETICS LLC

Provider Business Mailing Address
First Line	:	1963 THOMPSON RD
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2040
Country	:	US
Telephone Number	:	541-269-1773
Fax Number	:	541-269-2790

Provider Business Practice Location Address
First Line	:	1963 THOMPSON RD
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2040
Country	:	US
Telephone Number	:	541-269-1773
Fax Number	:	541-269-2790

Authorized Official
Title or Position	:	DIRECTOR
Name	:	FOREST SEXTON
Credential	:	CPO
Telephone Number	:	541-734-2435

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	05/22/2025

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