ACTIVE LIFE ORTHOTICS AND PROSTHETICS CORP. (NPI# 1528506821) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1528506821 |
Entity Type | Organization |
Organization Name | ACTIVE LIFE ORTHOTICS AND PROSTHETICS CORP. |
Practice Address |
6211 San Mateo Blvd Ne Suite 150 Albuquerque NM 87109-3533 |
Mailing Address |
908 Poco Cerro Ct Se Albuquerque NM 87123-4193 |
Practice Telephone | 5059104174 |
Mailing Telephone | 8185216837 |
Enumeration Date | 2017-02-07 |
Last Update Date | 2020-01-10 |
Authorized Official Name | DONALD DOTY (CLINICAL DIRECTOR) |
Authorized Official Telephone | 8185216837 |
Authorized Official Credential | CPO |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1285290437 | Active Life Orthotics and Prosthetics Corp. | Prosthetic/Orthotic Supplier | 2515 N Kentucky Ave, Roswell, NM 88201-5807 | 2019-05-14 |
Entity Type | Entity Name | Entity Address |
---|---|---|
System for Award Management (SAM) Entities | ACTIVE LIFE ORTHOTICS AND PROSTHETICS CORP. | 2515 N Kentucky Ave, Roswell, NM 88201-5807 |
Street Address |
6211 SAN MATEO BLVD NE SUITE 150 |
City | ALBUQUERQUE |
State | NM |
Zip Code | 87109-3533 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1104973155 | Richard J Vinnay | Social Worker | 6211 San Mateo Blvd Ne, Suite 170, Albuquerque, NM 87109-3533 | 2007-01-04 |
1396117321 | Leslie Flager | Mechanotherapist | 6211 San Mateo Blvd Ne, Suite 200, Albuquerque, NM 87109-3533 | 2015-10-29 |
1083053839 | The Medic Group, LLC | Health Maintenance Organization | 6211 San Mateo Blvd Ne, Albuquerque, NM 87109-3533 | 2013-06-14 |
1689970329 | Mesa Behavioral Management, Inc. | Counselor | 6211 San Mateo Blvd Ne, Suite 170, Albuquerque, NM 87109-3533 | 2011-01-27 |
1548382039 | Philip Jerome Tatoris | Social Worker | 6211 San Mateo Blvd Ne, Suite 170, Albuquerque, NM 87109-3533 | 2007-04-04 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1386286367 | Mikaela Epaloose | Behavior Technician | 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-10-11 |
1245872464 | Marsha Director | Behavior Technician | 100 Sun Avenue Ne, Ste 650, Albuquerque, NM 87109 | 2019-10-09 |
1720637499 | Nancy Gail Vice | Technician | 7319 Laguna Niguel Drive Ne, Albuquerque, NM 87109 | 2019-09-05 |
1598314411 | Chau Vu | Behavior Technician | Attn: Behavioral Health Works 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-09-04 |
1932753498 | Noelle Nielsen | Behavior Technician | 6401 Academy Rd. Ne Apt. 189, Albuquerque, NM 87109 | 2019-08-01 |
1952967952 | Caridad Merkel | Obstetrics & Gynecology | 6100 Pan American Fwy Ne Suite 450, Albuquerque, NM 87109 | 2019-05-15 |
1043795149 | Margaret Mcconville | Physical Therapist | Lovelace Women's Hospital Outpatient Rehabilitation, 4600 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-09-25 |
1922586262 | Clark Endodontics LLC | Dentist | 7520 Montgomery Blvd Ne Bldg E1, Albuquerque, NM 87109 | 2018-07-30 |
1447736202 | Melissa Christine Scott | Registered Nurse | Lovelace Women's Hospital, 4701 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-07-16 |
1508351990 | Gianna Nicole Casarez-quintana | Dentist | 7520 Montgomery Blvd Ne Bldg E10, Albuquerque, NM 87109 | 2018-06-27 |
Find all providers in zip 87109 |
Taxonomy Code | 335E00000X |
Grouping | Suppliers |
Classification | Prosthetic/Orthotic Supplier |
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1700347358 | Capitol Orthopedic Inc | Prosthetic/Orthotic Supplier | 401 Alvarado Dr Se Ste C, Albuquerque, NM 87108-2939 | 2019-03-27 |
1831653831 | Rio Grande Orthotics and Prosthetics | Prosthetic/Orthotic Supplier | 4824 Mcmahon Blvd Nw Ste 112, Albuquerque, NM 87114-5412 | 2019-01-24 |
1336613298 | Mid Star Lab Inc | Prosthetic/Orthotic Supplier | 401 Alvarado Dr Se, Albuquerque, NM 87108-2939 | 2019-01-14 |
1548679897 | Functional Orthotics & Prosthetics | Prosthetic/Orthotic Supplier | 5111 Juan Tabo Blvd Ne Ste A, Albuquerque, NM 87111-2672 | 2014-08-11 |
1104187855 | Lower Extremity International LLC | Prosthetic/Orthotic Supplier | 9428 Lexington Ave Ne Suite E, Albuquerque, NM 87112-1375 | 2012-05-30 |
1639488588 | Estetica De Ella Salon (cranial Prosthesis) | Prosthetic/Orthotic Supplier | 2510 San Mateo Pl Ne, Albuquerque, NM 87110-4064 | 2010-09-27 |
1528276318 | Albuquerque Orthotics & Prosthetics | Prosthetic/Orthotic Supplier | 4909 Ellison St Ne, Suite A, Albuquerque, NM 87109-4331 | 2007-05-18 |
1740236819 | Active Life Inc | Prosthetic/Orthotic Supplier | 124 Alvarado Dr Se, Albuquerque, NM 87108-2940 | 2006-05-26 |
1902883473 | Prosthetic Orthotic Specialists, Inc | Prosthetic/Orthotic Supplier | 5095 Ellison St Ne, Albuquerque, NM 87109-4326 | 2005-12-27 |
1891354197 | Active Life Orthotics and Prosthetics Corp | Prosthetic/Orthotic Supplier | 124 Alvarado Dr Se, Albuquerque, NM 87108-2940 | 2019-06-10 |
Find all providers in ALBUQUERQUE |
City | ALBUQUERQUE |
Zip Code | 87109 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.