Provider Demographics
NPI:1740311067
Name:NORTHERN ARM & HAND CENTER, INC.
Entity type:Organization
Organization Name:NORTHERN ARM & HAND CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:NIELAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CHT
Authorized Official - Phone:218-728-3774
Mailing Address - Street 1:1420 LONDON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2433
Mailing Address - Country:US
Mailing Address - Phone:218-728-3774
Mailing Address - Fax:218-728-3640
Practice Address - Street 1:1420 LONDON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2433
Practice Address - Country:US
Practice Address - Phone:218-728-3774
Practice Address - Fax:218-728-3640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN37B96NOOtherBCBSM DMERC
MN671517600Medicaid
MN671517600Medicaid