Provider Demographics
NPI:1306953930
Name:BUFFALO ORTHOTICS & PROSTHETICS, INC.
Entity type:Organization
Organization Name:BUFFALO ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HUSOM
Authorized Official - Suffix:
Authorized Official - Credentials:CPED, CO, OST
Authorized Official - Phone:763-684-1800
Mailing Address - Street 1:112 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1402
Mailing Address - Country:US
Mailing Address - Phone:763-684-1800
Mailing Address - Fax:
Practice Address - Street 1:112 1ST ST S
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1402
Practice Address - Country:US
Practice Address - Phone:763-684-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8200189OtherMEDICA
MN74624OtherHEALTH PARTNERS
MN32773DAOtherBCBS #
MN1044066OtherPREFERRED ONE
MN1044066OtherPREFERRED ONE