Healthcare Provider Details

I. General information

NPI: 1437525292
Provider Name (Legal Business Name): ORTHOCURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6636 CEDAR AVE S STE 170
RICHFIELD MN
55423-2710
US

IV. Provider business mailing address

6636 CEDAR AVE S STE 170
RICHFIELD MN
55423-2710
US

V. Phone/Fax

Practice location:
  • Phone: 844-934-3258
  • Fax:
Mailing address:
  • Phone: 844-934-3258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number499997
License Number StateMN

VIII. Authorized Official

Name: MRS. JODI K HANSON
Title or Position: CEO
Credential:
Phone: 651-210-6388