Provider Demographics
NPI:1356589113
Name:NORTH METRO ORTHOTICS AND PROSTHETICS, INC
Entity type:Organization
Organization Name:NORTH METRO ORTHOTICS AND PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-784-6647
Mailing Address - Street 1:8290 UNIVERSITY AVE NE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-1847
Mailing Address - Country:US
Mailing Address - Phone:763-784-6647
Mailing Address - Fax:763-784-7747
Practice Address - Street 1:3111 124TH AVE NW
Practice Address - Street 2:SUITE 210
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4572
Practice Address - Country:US
Practice Address - Phone:763-323-6921
Practice Address - Fax:763-323-6940
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH METRO ORTHOTICS AND PROSTHETICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-30
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier