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General NPI Number Information
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NPI Number | 1689699480
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Entity Type | Organization
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Legal Business Name | HAGEN ORTHOTICS AND PROSTHETICS
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 306 BECKER AVE SW
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City | WILLMAR
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State | MN
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Zip | 56201-3341
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Country | US
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Telephone | 320-222-3260
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Fax | 320-222-3262
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Provider Business Mailing Address
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Address Line | 306 BECKER AVE SW
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City | WILLMAR
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State | MN
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Zip | 56201-3341
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Country | US
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Telephone | 320-222-3260
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Fax | 320-222-3262
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Authorized Official
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Title or Position | OWNER/ORTHOTIST
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Name | MR. WARREN HAGEN
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Credential | CO, C.PED, PTA
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Telephone | 320-222-3260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CO003977
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License Number State |
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