Provider Demographics
NPI:1104163187
Name:WESTLAKE ORTHOTICS AND PROSTHETICS INC
Entity type:Organization
Organization Name:WESTLAKE ORTHOTICS AND PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WESTLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:651-291-9000
Mailing Address - Street 1:360 SHERMAN ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2564
Mailing Address - Country:US
Mailing Address - Phone:651-291-9000
Mailing Address - Fax:651-291-8894
Practice Address - Street 1:360 SHERMAN ST
Practice Address - Street 2:SUITE 160
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2564
Practice Address - Country:US
Practice Address - Phone:651-291-9000
Practice Address - Fax:651-291-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6723510001Medicare NSC