Provider Demographics
NPI:1205138625
Name:NORTHERN ORTHOTICS & PROSTHETICS, INC
Entity type:Organization
Organization Name:NORTHERN ORTHOTICS & PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PENFOLD
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:906-353-7161
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 1:20075 3RD ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-9805
Practice Address - Country:US
Practice Address - Phone:906-482-7733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier