Provider Demographics
NPI:1457434730
Name:TANDEM ORTHOTICS AND PROSTHETICS, INC.
Entity Type:Organization
Organization Name:TANDEM ORTHOTICS AND PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHOONMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:320-252-9211
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-0297
Mailing Address - Country:US
Mailing Address - Phone:320-252-9211
Mailing Address - Fax:320-252-9244
Practice Address - Street 1:2380 TROOP DR
Practice Address - Street 2:SUITE 204
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4636
Practice Address - Country:US
Practice Address - Phone:320-252-9211
Practice Address - Fax:320-252-9244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN151142OtherU-CARE
MN56521OtherHEALTH PARTNERS
MN60054OtherAETNA
MN03G40TAOtherBCBS
MN82-14551OtherMEDICA
MN4732197-00Medicaid
MN1019369OtherPREFERRED ONE