Provider Demographics
NPI:1023092475
Name:TWIN CITIES ORTHOTIC & PROSTHETIC SERVICES
Entity type:Organization
Organization Name:TWIN CITIES ORTHOTIC & PROSTHETIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:269-983-6118
Mailing Address - Street 1:709 MIDWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2438
Mailing Address - Country:US
Mailing Address - Phone:269-983-6118
Mailing Address - Fax:269-983-7577
Practice Address - Street 1:709 MIDWAY AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2438
Practice Address - Country:US
Practice Address - Phone:269-983-6118
Practice Address - Fax:269-983-7577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
Not Answered225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8231127OtherPHP
MI5955OtherHEALTH PLAN
2598OtherGREAT LAKES HEALTH
52539OtherNORTHWOOD
52539OtherNORTHWOOD
MI5955OtherHEALTH PLAN