Healthcare Provider Details

I. General information

NPI: 1306896808
Provider Name (Legal Business Name): ORTHOTIC & PROSTHETIC SPECIALTIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 E 26TH ST
SIOUX FALLS SD
57103-4034
US

IV. Provider business mailing address

2910 E 26TH ST
SIOUX FALLS SD
57103-4034
US

V. Phone/Fax

Practice location:
  • Phone: 605-334-2311
  • Fax: 605-334-7748
Mailing address:
  • Phone: 605-334-2311
  • Fax: 605-334-7748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CHRISTOPHER BERDAHL
Title or Position: PRESIDENT
Credential: CP
Phone: 605-334-2311