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PROSTHETIC DEVELOPMENT AND RESEARCH INC. NPI 1104859248


NPI Information

NPI: 1104859248
Provider Name: PROSTHETIC DEVELOPMENT AND RESEARCH, INC.

Doing Business As: SAN JUAN PROSTHETICS AND ORTHOTICS, LLC

Classification: Prosthetic/Orthotic Supplier - 335E00000X
Entity Type: Organization
Address:
1 MERCADO ST
STE. 203
DURANGO, CO
ZIP 81301
Phone: (970) 259-9258
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PROSTHETIC DEVELOPMENT AND RESEARCH, INC. is a prosthetic orthotic supplier in Durango, CO. The provider is an organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. PROSTHETIC DEVELOPMENT AND RESEARCH, INC. NPI is 1104859248. The provider is registered as an organization entity type.
The provider Is Doing Business As San Juan Prosthetics And Orthotics, Llc.

The provider's business location address is:

1 MERCADO ST
STE. 203
DURANGO, CO
ZIP 81301-300
Phone: (970) 259-9258
Fax: (970) 385-7262

The provider's authorized official is Timothy John Obrien .
The authorized official title is President and has the following contact phone number (970) 259-9258.

The enumeration date for this NPI number is 7/9/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1335E00000XProsthetic/Orthotic Supplier1428ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
108002149MEDICAIDCOLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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