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General NPI Number Information
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NPI Number | 1437525292
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Entity Type | Organization
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Legal Business Name | ORTHOCURE LLC
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 6636 CEDAR AVE S STE 170
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City | RICHFIELD
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State | MN
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Zip | 55423-2710
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Country | US
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Telephone | 844-934-3258
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Fax |
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Provider Business Mailing Address
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Address Line | 6636 CEDAR AVE S STE 170
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City | RICHFIELD
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State | MN
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Zip | 55423-2710
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Country | US
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Telephone | 844-934-3258
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. JODI K HANSON
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Credential |
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Telephone | 651-210-6388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 499997
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License Number State | MN
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