NPIMap

Organization Active NPI

Prosthetic Development and Research, Inc.

Doing business as San Juan Prosthetics and Orthotics, LLC

  • Prosthetic/Orthotic Supplier
  • Durango, CO
National Provider Identifier
1104859248
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
1428 Issued in IL
Legal business name
PROSTHETIC DEVELOPMENT AND RESEARCH, INC.
Doing business as
San Juan Prosthetics and Orthotics, LLC
Practice address
1 Mercado St
Ste. 203
Durango, CO 81301-7300
Phone
(970) 259-9258
Fax
(970) 385-7262
NPI assigned
Jul 9, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Timothy John Obrien, C.P.O.NPI 1609803758
Title
President
Phone
(970) 259-9258

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X 1428 IL Primary

Addresses

Primary practice location

1 Mercado St
Ste. 203
Durango, CO 81301-7300

Mailing address

1 Mercado St
Ste. 203
Durango, CO 81301-7300
Phone (970) 259-9258

Other names 1

  • San Juan Prosthetics and Orthotics, LLC Doing business as

National Provider Directory

National Provider Directory

Locations

1 Mercado St
Ste 203
Durango, CO 81301
Phone (970) 259-9258

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104859248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MERCADO ST",
            "address_2": "STE. 203",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813017300",
            "telephone_number": "970-259-9258",
            "fax_number": "970-385-7262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MERCADO ST",
            "address_2": "STE. 203",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813017300",
            "telephone_number": "970-259-9258",
            "fax_number": "970-385-7262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSTHETIC DEVELOPMENT AND RESEARCH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OBRIEN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "970-259-9258",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.P.O."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "IL",
            "license": "1428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Juan Prosthetics and Orthotics, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Durango, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.