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1447222054

NPI Code Detail

MEDICARE: CUSTOM CARE ORTHOTICS, INC

MEDICARE: CUSTOM CARE ORTHOTICS, 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	82-00444	OTHER	MN	SELECT CARE
2	164659	OTHER	MN	UCARE MINNESOTA
3	165L9CU	OTHER	MN	BLUE CROSS BLUE SHIELD
4	96446	OTHER	MN	HEALTH PARTNERS
5	82-00444	OTHER	MN	UNITED HEALTH CARE
6	01035214	OTHER	MN	PREFERRED ONE
7	82-00444	OTHER	MN	MEDICA

General Provider Information

NPI Number	:	1447222054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUSTOM CARE ORTHOTICS, INC

Provider Business Mailing Address
First Line	:	910 E 26TH ST
Second Line	:	460
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4526
Country	:	US
Telephone Number	:	612-871-5000
Fax Number	:	612-871-3800

Provider Business Practice Location Address
First Line	:	910 E 26TH ST
Second Line	:	460
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4526
Country	:	US
Telephone Number	:	612-871-5000
Fax Number	:	612-871-3800

Authorized Official
Title or Position	:	OWNER/ORTHOTIST
Name	:	CAROL JEAN HENTGES
Credential	:	C.O.
Telephone Number	:	612-871-5000

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

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Practice Location Address:

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1053390757 — AMY K YILEK RN, CNP
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1720057870 — THOMAS P FLYNN M.D.
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910 E 26TH ST , SUITE 100-200
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1316915408 — MARGARET A MACRAE M.D.
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910 E 26TH ST , STE 100
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1831158062 — PAUL J ZANDER M.D.
Practice Location Address:

910 E 26TH ST , STE 200
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1477522639 — JOHN E SENG M.D.
Practice Location Address:

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Directions to “CUSTOM CARE ORTHOTICS, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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