MEDICARE: NORTHERN PROSTHETICS & ORTHOPEDIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0010180001	OTHER	IL	BCBS OF IL HMO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194719328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN PROSTHETICS & ORTHOPEDIC INC

Provider Business Mailing Address
First Line	:	2629 CHARLES ST
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-1608
Country	:	US
Telephone Number	:	815-226-0444
Fax Number	:	815-226-1819

Provider Business Practice Location Address
First Line	:	2629 CHARLES ST
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-1608
Country	:	US
Telephone Number	:	815-226-0444
Fax Number	:	815-226-1819

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ERICH HERBERT SCHULZE
Credential	:	CPO, C.PED
Telephone Number	:	815-226-0444

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	05/14/2020

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