Provider Demographics
NPI:1548340136
Name:WESTERN SLOPE ORTHOTICS
Entity type:Organization
Organization Name:WESTERN SLOPE ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:C O
Authorized Official - Phone:970-243-9255
Mailing Address - Street 1:840 ROOD AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3434
Mailing Address - Country:US
Mailing Address - Phone:970-241-7042
Mailing Address - Fax:970-248-0083
Practice Address - Street 1:840 ROOD AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3434
Practice Address - Country:US
Practice Address - Phone:970-241-7042
Practice Address - Fax:970-248-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT841108342008Medicaid
CO08175903Medicaid
UT841108342008Medicaid