Organization
PROSTHETIC CARE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHAN SMITH (CERTIFIED ORTHOTIST PROSTHETIST)
(720) 795-6438
Entity
Organization
Contact information
Practice address
812 MAIN ST, FORT MORGAN, CO 80701-2030
(970) 743-3118
(707) 433-1219
Mailing address
812 MAIN ST, FORT MORGAN, CO 80701-2030
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
10/09/2020
Last updated
03/16/2023
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