Provider Demographics
NPI:1184682130
Name:NORTHERN BRACE COMPANY INC
Entity Type:Organization
Organization Name:NORTHERN BRACE COMPANY INC
Other - Org Name:NORTHERN BRACE NORTHERN PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-755-2300
Mailing Address - Street 1:610 N MICHIGAN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1077
Mailing Address - Country:US
Mailing Address - Phone:574-233-4221
Mailing Address - Fax:
Practice Address - Street 1:610 N MICHIGAN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1077
Practice Address - Country:US
Practice Address - Phone:574-233-4221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100153030AMedicaid
IN0196180001Medicare NSC