Provider Demographics
NPI:1891764403
Name:NORTHERN ORTHOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:NORTHERN ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-273-2444
Mailing Address - Street 1:509 S SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:BARAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49908-9698
Mailing Address - Country:US
Mailing Address - Phone:906-353-7161
Mailing Address - Fax:906-353-7000
Practice Address - Street 1:509 S SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:BARAGA
Practice Address - State:MI
Practice Address - Zip Code:49908-9698
Practice Address - Country:US
Practice Address - Phone:906-353-7161
Practice Address - Fax:906-353-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302Z702540OtherMI BLUE CROSS
MI5090909Medicaid
MI5090909Medicaid