Provider Demographics
NPI:1962579482
Name:NORTHERN ORTHOTICS AND PROSTHETIC SERVICES CORPORATION
Entity type:Organization
Organization Name:NORTHERN ORTHOTICS AND PROSTHETIC SERVICES CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FRANCISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-249-6250
Mailing Address - Street 1:925 EAST SUPERIOR ST
Mailing Address - Street 2:STE 102
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802
Mailing Address - Country:US
Mailing Address - Phone:218-249-6250
Mailing Address - Fax:218-249-6255
Practice Address - Street 1:925 EAST SUPERIOR ST
Practice Address - Street 2:STE 102
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802
Practice Address - Country:US
Practice Address - Phone:218-249-6250
Practice Address - Fax:218-249-6255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN064985600Medicaid
854766680OtherMICHIGAN MEDICAL MEDICAID
1041273OtherPREFERRED ONE MN
MN8200357OtherMEDICA
99369OtherHEALTH PARTNERS MN
MN121T8NOOtherBCBS OF MN
165374OtherUCARE MINNESOTA
41788600OtherWISCONSIN MEDICAID EDS
854766680OtherMICHIGAN MEDICAL MEDICAID
MN4652170001Medicare PIN