Provider Demographics
NPI:1194953935
Name:ORTHOTIC CARE SERVICES, LLC
Entity type:Organization
Organization Name:ORTHOTIC CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHOTIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HINSHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-871-1480
Mailing Address - Street 1:2545 CHICAGO AVE STE 412
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4566
Mailing Address - Country:US
Mailing Address - Phone:612-871-1480
Mailing Address - Fax:612-871-1498
Practice Address - Street 1:2545 CHICAGO AVE STE 412
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4566
Practice Address - Country:US
Practice Address - Phone:612-871-1480
Practice Address - Fax:612-871-1498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Z00000X, 224P00000X
MN335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0543190001OtherMEDICARE PTAN
MN032763800Medicaid