Healthcare Provider Details
I. General information
NPI: 1023823812
Provider Name (Legal Business Name): ORTHOTIC CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7767 ELM CREEK BLVD N STE 208
MAPLE GROVE MN
55369-7033
US
IV. Provider business mailing address
2545 CHICAGO AVE STE 412
MINNEAPOLIS MN
55404-4566
US
V. Phone/Fax
- Phone: 612-871-1480
- Fax: 612-871-1498
- Phone: 612-871-1480
- Fax: 612-871-1498
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 335E00000X |
| Taxonomy | Prosthetic/Orthotic Supplier |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
PATRICK
SCOTT
HINSHON
Title or Position: OWNER, PRACTITIONER
Credential:
Phone: 612-871-1480