MEDICARE: COMPLETE PROSTHETICS & ORTHOTICS 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	:	1407631310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE PROSTHETICS & ORTHOTICS LLC

Provider Business Mailing Address
First Line	:	9632 W EMERALD ST STE A
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-9762
Country	:	US
Telephone Number	:	208-609-6526
Fax Number	:

Provider Business Practice Location Address
First Line	:	9632 W EMERALD ST STE A
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-9762
Country	:	US
Telephone Number	:	208-609-6526
Fax Number	:

Authorized Official
Title or Position	:	CLINIC ADMIN
Name	:	JANENE MAUGHAN
Credential	:
Telephone Number	:	208-609-6526

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	09/25/2023

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