Provider Demographics
NPI:1326486242
Name:OTTOBOCK MEDICALCARE LLC
Entity Type:Organization
Organization Name:OTTOBOCK MEDICALCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-253-5679
Mailing Address - Street 1:2 CARLSON PKWY N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4466
Mailing Address - Country:US
Mailing Address - Phone:763-253-5679
Mailing Address - Fax:763-253-5779
Practice Address - Street 1:14800 28TH AVE N
Practice Address - Street 2:SUITE 110-A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55447-4873
Practice Address - Country:US
Practice Address - Phone:800-328-4058
Practice Address - Fax:763-253-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6991950001Medicare NSC