Provider Demographics
NPI:1245276641
Name:COLBURN ORTHOPEDICS, INC.
Entity type:Organization
Organization Name:COLBURN ORTHOPEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:COLBURN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:814-432-5252
Mailing Address - Street 1:302 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-2212
Mailing Address - Country:US
Mailing Address - Phone:814-432-5252
Mailing Address - Fax:814-432-7082
Practice Address - Street 1:302 GRANT ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-2212
Practice Address - Country:US
Practice Address - Phone:814-432-5252
Practice Address - Fax:814-432-7082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015736710002Medicaid
PA0015736710002Medicaid