MEDICARE: HIGH COUNTRY ORTHOTICS & PROSTHETICS

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
2	222Z00000X	Orthotist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	312903	OTHER	WY	BLUECROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912903105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH COUNTRY ORTHOTICS & PROSTHETICS

Provider Business Mailing Address
First Line	:	135 S WASHINGTON ST.
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2738
Country	:	US
Telephone Number	:	307-234-4214
Fax Number	:	307-237-1228

Provider Business Practice Location Address
First Line	:	135 S WASHINGTON ST.
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2738
Country	:	US
Telephone Number	:	307-234-4214
Fax Number	:	307-237-1228

Authorized Official
Title or Position	:	OWNER
Name	:	HENRY ARTHUR OSBORNE
Credential	:	CO
Telephone Number	:	307-234-4214

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	01/04/2016

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