Provider Demographics
NPI:1689747693
Name:NORTHLAND ORTHOPEDIC APPLICANCE INC
Entity Type:Organization
Organization Name:NORTHLAND ORTHOPEDIC APPLICANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER PART OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-454-6060
Mailing Address - Street 1:4321 NE VIVION RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2838
Mailing Address - Country:US
Mailing Address - Phone:816-454-6060
Mailing Address - Fax:816-453-6997
Practice Address - Street 1:4321 NE VIVION RD
Practice Address - Street 2:SUITE 104
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-2838
Practice Address - Country:US
Practice Address - Phone:816-454-6060
Practice Address - Fax:816-453-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
31045011OtherBLUE SHIELD
7058559OtherAETNA
MO4429900001Medicare ID - Type Unspecified