MEDICARE: NORTHLAND ORTHOPEDIC APPLICANCE 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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31045011	OTHER		BLUE SHIELD
2	7058559	OTHER		AETNA

General Provider Information

NPI Number	:	1689747693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND ORTHOPEDIC APPLICANCE INC

Provider Business Mailing Address
First Line	:	4321 NE VIVION RD
Second Line	:	SUITE 104
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2838
Country	:	US
Telephone Number	:	816-454-6060
Fax Number	:	816-453-6997

Provider Business Practice Location Address
First Line	:	4321 NE VIVION RD
Second Line	:	SUITE 104
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2838
Country	:	US
Telephone Number	:	816-454-6060
Fax Number	:	816-453-6997

Authorized Official
Title or Position	:	SECRETARY TREASURER PART OWNER
Name	:	MRS. PATRICIA M WILMS
Credential	:
Telephone Number	:	816-454-6060

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	08/22/2020

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