Provider Demographics
NPI:1225033053
Name:THE FITTING PLACE, INC
Entity type:Organization
Organization Name:THE FITTING PLACE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KAI
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:515-225-3043
Mailing Address - Street 1:1440 22ND ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1403
Mailing Address - Country:US
Mailing Address - Phone:515-225-3043
Mailing Address - Fax:515-225-0184
Practice Address - Street 1:1440 22ND ST
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1403
Practice Address - Country:US
Practice Address - Phone:515-225-3043
Practice Address - Fax:515-225-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1164145Medicaid
IA0203800001Medicare NSC