Healthcare Provider Details

I. General information

NPI: 1023092475
Provider Name (Legal Business Name): TWIN CITIES ORTHOTIC & PROSTHETIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 MIDWAY AVE
SAINT JOSEPH MI
49085-2438
US

IV. Provider business mailing address

709 MIDWAY AVE
SAINT JOSEPH MI
49085-2438
US

V. Phone/Fax

Practice location:
  • Phone: 269-983-6118
  • Fax: 269-983-7577
Mailing address:
  • Phone: 269-983-6118
  • Fax: 269-983-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE CARL HART
Title or Position: PRES OWNER
Credential: CPO
Phone: 269-983-6118