Healthcare Provider Details

I. General information

NPI: 1598749319
Provider Name (Legal Business Name): GREAT PLAINS ORTHOTICS & PROSTHETICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 E LINCOLN WAY
AMES IA
50010-6664
US

IV. Provider business mailing address

PO BOX 650846
DALLAS TX
75265-0846
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-3927
  • Fax: 515-232-8517
Mailing address:
  • Phone: 515-232-3927
  • Fax: 515-232-8517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateIA

VIII. Authorized Official

Name: SHERYL S PRICE
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 503-493-8288