Healthcare Provider Details

I. General information

NPI: 1689699480
Provider Name (Legal Business Name): HAGEN ORTHOTICS AND PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 BECKER AVE SW
WILLMAR MN
56201-3341
US

IV. Provider business mailing address

306 BECKER AVE SW
WILLMAR MN
56201-3341
US

V. Phone/Fax

Practice location:
  • Phone: 320-222-3260
  • Fax: 320-222-3262
Mailing address:
  • Phone: 320-222-3260
  • Fax: 320-222-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCO003977
License Number State

VIII. Authorized Official

Name: MR. WARREN HAGEN
Title or Position: OWNER/ORTHOTIST
Credential: CO, C.PED, PTA
Phone: 320-222-3260