1962579482 NPI number — NORTHERN ORTHOTICS AND PROSTHETIC SERVICES CORPORATION

Table of content: (NPI 1962579482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962579482 NPI number — NORTHERN ORTHOTICS AND PROSTHETIC SERVICES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN ORTHOTICS AND PROSTHETIC SERVICES CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTHERN ORTHOTIC AND PROSTHETIC CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962579482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 EAST SUPERIOR ST
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-249-6250
Provider Business Mailing Address Fax Number:
218-249-6255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 EAST SUPERIOR ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-249-6250
Provider Business Practice Location Address Fax Number:
218-249-6255
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRANCISCO
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
218-249-6250

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 064985600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 854766680 . This is a "MICHIGAN MEDICAL MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1041273 . This is a "PREFERRED ONE MN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8200357 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 99369 . This is a "HEALTH PARTNERS MN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121T8NO . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 165374 . This is a "UCARE MINNESOTA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41788600 . This is a "WISCONSIN MEDICAID EDS" identifier . This identifiers is of the category "OTHER".




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