Active NPI
Orthotic & Prosthetic Health
- Prosthetic/Orthotic Supplier
- Detroit Lakes, MN
National Provider Identifier
1649386293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- License
- CO1105
- Legal business name
- ORTHOTIC & PROSTHETIC HEALTH
- Practice address
- 214 Front St W
Detroit Lakes, MN 56501-3020 - Phone
- (218) 847-6767
- Fax
- (218) 847-7676
- NPI assigned
- Aug 23, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Robert E Johansen, CO
- Title
- President
- Phone
- (218) 847-6767
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | CO1105 | MN | Primary |
Addresses
Primary practice location
214 Front St W
Detroit Lakes, MN 56501-3020
Mailing address
810 S Maple St
Watertown, SD 57201
Phone (605) 886-3272
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 431G30R | Other | MN | BCBS |
| 9162720 | Medicaid | SD | |
| 5026500002 | Other | MN | MEDICINE B |
| 58576100 | Medicaid | MN |
Other names 1
- O & P Health
National Provider Directory
National Provider Directory- Tax ID family
- O P Health
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Watertown, SD
- NPI 1053461863
Locations
214 Front St W
Detroit Lakes, MN 56501
Phone (218) 847-6767
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1649386293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "810 S MAPLE ST",
"city": "WATERTOWN",
"state": "SD",
"postal_code": "57201",
"telephone_number": "605-886-3272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "214 FRONT ST W",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "565013020",
"telephone_number": "218-847-6767",
"fax_number": "218-847-7676"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ORTHOTIC & PROSTHETIC HEALTH",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-23",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "JOHANSEN",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "218-847-6767",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "CO"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "MN",
"license": "CO1105",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "431G30R",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9162720",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICINE B",
"identifier": "5026500002",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "58576100",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "O & P Health",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Detroit Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.