Provider Demographics
NPI:1598576613
Name:TILLGES CERTIFIED ORTHOTIC PROSTHETIC, INC.
Entity type:Organization
Organization Name:TILLGES CERTIFIED ORTHOTIC PROSTHETIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-379-5581
Mailing Address - Street 1:1570 BEAM AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3136
Mailing Address - Country:US
Mailing Address - Phone:651-772-2665
Mailing Address - Fax:
Practice Address - Street 1:3879 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2518
Practice Address - Country:US
Practice Address - Phone:651-772-2665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier