Provider Demographics
NPI:1568532190
Name:ORTHOPEDIC SPECIALISTS, P.A.
Entity Type:Organization
Organization Name:ORTHOPEDIC SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BOXALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-915-8300
Mailing Address - Street 1:6600 FRANCE AVE S STE 605
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1807
Mailing Address - Country:US
Mailing Address - Phone:952-920-4333
Mailing Address - Fax:952-920-2561
Practice Address - Street 1:6600 FRANCE AVE S STE 605
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1807
Practice Address - Country:US
Practice Address - Phone:952-920-4333
Practice Address - Fax:952-920-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN462207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN06226OROtherBLUE CROSS BLUE SHIELD
MNA96119Medicare UPIN
C01152Medicare ID - Type Unspecified
MN06226OROtherBLUE CROSS BLUE SHIELD