Provider Demographics
NPI:1508130014
Name:ORTHOTIC & PROSTHETIC SPECIALTIES, INC.
Entity Type:Organization
Organization Name:ORTHOTIC & PROSTHETIC SPECIALTIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BERDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:605-334-2311
Mailing Address - Street 1:2211 8TH AVE NE
Mailing Address - Street 2:SUITE 3102
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-3241
Mailing Address - Country:US
Mailing Address - Phone:605-725-2311
Mailing Address - Fax:605-725-2312
Practice Address - Street 1:2211 8TH AVE NE
Practice Address - Street 2:SUITE 3102
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-3241
Practice Address - Country:US
Practice Address - Phone:605-725-2311
Practice Address - Fax:605-725-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier