Provider Demographics
NPI:1902985906
Name:THE WINKLEY COMPANY
Entity Type:Organization
Organization Name:THE WINKLEY COMPANY
Other - Org Name:WINKLEY ORTHOTICS AND PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:GRUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:763-546-1177
Mailing Address - Street 1:740 DOUGLAS DR N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4301
Mailing Address - Country:US
Mailing Address - Phone:763-546-1177
Mailing Address - Fax:763-847-9508
Practice Address - Street 1:910 E 26TH ST
Practice Address - Street 2:SUITE 323
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4526
Practice Address - Country:US
Practice Address - Phone:612-863-8963
Practice Address - Fax:612-863-8962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41776500Medicaid
MN761972000Medicaid
WI41776500Medicaid