Provider Demographics
NPI:1194719328
Name:NORTHERN PROSTHETICS & ORTHOPEDIC INC
Entity type:Organization
Organization Name:NORTHERN PROSTHETICS & ORTHOPEDIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:SCHULZE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, CPED
Authorized Official - Phone:815-226-0444
Mailing Address - Street 1:2629 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-1608
Mailing Address - Country:US
Mailing Address - Phone:815-226-0444
Mailing Address - Fax:815-226-1819
Practice Address - Street 1:2629 CHARLES ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1608
Practice Address - Country:US
Practice Address - Phone:815-226-0444
Practice Address - Fax:815-226-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0010180001OtherBCBS OF IL HMO
WI41783100Medicaid
IL=========001Medicaid
IL1298660001Medicare NSC