Provider Demographics
NPI:1366540569
Name:SPECTRUM ORTHOTICS AND PROSTHETICS, INC
Entity type:Organization
Organization Name:SPECTRUM ORTHOTICS AND PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FOREST
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:541-955-9678
Mailing Address - Street 1:1180 CRATER LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6242
Mailing Address - Country:US
Mailing Address - Phone:541-734-2435
Mailing Address - Fax:541-734-4366
Practice Address - Street 1:2231 N ELDORADO AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6417
Practice Address - Country:US
Practice Address - Phone:541-844-5348
Practice Address - Fax:541-844-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier