Healthcare Provider Details

I. General information

NPI: 1740245869
Provider Name (Legal Business Name): WOMEN'S ORTHOTICS & PROSTHESTICS HEALTHCARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 29TH AVE SUITE 4
KEARNEY NE
68845-1280
US

IV. Provider business mailing address

3811 29TH AVE SUITE 4
KEARNEY NE
68845-1280
US

V. Phone/Fax

Practice location:
  • Phone: 308-238-2230
  • Fax: 308-238-2229
Mailing address:
  • Phone: 308-238-2230
  • Fax: 308-238-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MANDI J SEDLAK
Title or Position: PRESIDENT
Credential: CMS
Phone: 308-238-2230