Provider Demographics
NPI:1306896808
Name:ORTHOTIC & PROSTHETIC SPECIALTIES, INC
Entity type:Organization
Organization Name:ORTHOTIC & PROSTHETIC SPECIALTIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BERDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:605-334-2311
Mailing Address - Street 1:2910 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4034
Mailing Address - Country:US
Mailing Address - Phone:605-334-2311
Mailing Address - Fax:605-334-7748
Practice Address - Street 1:2910 E 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-4034
Practice Address - Country:US
Practice Address - Phone:605-334-2311
Practice Address - Fax:605-334-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9150580Medicaid
IA0544775Medicaid
SD4997360OtherBLUE CROSS BLUE SHIELD
MN8769338-00Medicaid
IA0544775Medicaid