MEDICARE: GREAT PLAINS ORTHOTICS & PROSTHETICS, 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	332BC3200X	Customized Equipment (DME)
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1346310901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT PLAINS ORTHOTICS & PROSTHETICS, INC

Provider Business Mailing Address
First Line	:	PO BOX 650846
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0846
Country	:	US
Telephone Number	:	563-359-1943
Fax Number	:	563-359-1875

Provider Business Practice Location Address
First Line	:	3520 JERSEY RIDGE RD
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-2223
Country	:	US
Telephone Number	:	563-359-1943
Fax Number	:	563-359-1875

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	SHERYL S PRICE
Credential	:
Telephone Number	:	503-493-8288

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	03/06/2014

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