MEDICARE: COLUMBIA O & P LABS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	122475	OTHER	BCBS
2	11807	OTHER	HEALTHCARE USA
3	433956	OTHER	HEALTHLINK

General Provider Information

NPI Number	:	1366622771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA O & P LABS

Provider Business Mailing Address
First Line	:	1735 SOUTHWEST BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-2435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 SOUTHWEST BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-2435
Country	:	US
Telephone Number	:	573-635-0006
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM ABBOTT
Credential	:	CP
Telephone Number	:	573-635-0006

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	04/20/2008

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Directions to “COLUMBIA O & P LABS ” Practice Location

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