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KOOTENAI PROSTHETIC AND ORTHOTIC SERVICES

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Company Details

Name: KOOTENAI PROSTHETIC AND ORTHOTIC SERVICES
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 03 Jun 2004 (21 years ago)
Entity Number: 241099
Place of Formation: IDAHO
File Number: 0000241099
ZIP code: 83814
County: Kootenai County
Mailing Address: 1321 NORTHWOOD CENTER CT COEUR D ALENE, ID 83814

National Provider Identifier

NPI Number:
1023379377
Certification Date:
2025-07-10

Authorized Person:

Name:
STEPHEN ANTHONY BLAS
Role:
CPO/ VICE PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
335E00000X - Prosthetic/Orthotic Supplier
Is Primary:
Yes

Contacts:

Fax:
2084571659

Filing

Filing Name Filing Number Filing date
Initial Filing 0000241099 2004-06-03

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Date of last update: 24 Sep 2024

Sources: Idaho Secretary of State