Provider Demographics
NPI:1114412566
Name:OSTEOGENIC MEDICAL LLC
Entity Type:Organization
Organization Name:OSTEOGENIC MEDICAL LLC
Other - Org Name:SMART RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PAYMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KASS
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-368-7391
Mailing Address - Street 1:3109 W 50TH ST STE 337
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2102
Mailing Address - Country:US
Mailing Address - Phone:612-991-3343
Mailing Address - Fax:
Practice Address - Street 1:4445 W 77TH ST STE 108
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5134
Practice Address - Country:US
Practice Address - Phone:612-368-7391
Practice Address - Fax:612-424-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies