GILLETTE CHILDREN'S SPECILATY HEALTHCARE (NPI# 1033278270) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033278270 |
| Entity Type | Organization |
| Organization Name | GILLETTE CHILDREN'S SPECILATY HEALTHCARE |
| Other Organization Name | GILLETTE CHILDREN'S HEALTHCARE OUTREACH-DME |
| Practice Address |
435 Phalen Blvd Gillette Lifetime Speciality Healthcare Saint Paul MN 55101-5302 |
| Mailing Address |
200 University Ave E Saint Paul MN 55101-2507 |
| Practice Telephone | 6516369443 |
| Mailing Telephone | 6513252104 |
| Mailing Fax Number | 6513252174 |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | MR. HADRIAN V MOORE (PATIENT ACCOUNTING MANAGER) |
| Authorized Official Telephone | 6513252104 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 335E00000X | Prosthetic/Orthotic Supplier | MN | Suppliers | |
| X | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| X | 332BC3200X |
Durable Medical Equipment & Medical Supplies Specialization: Customized Equipment |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | DMERC | 0426920003 | 01 |
| Other Name | Type Code |
|---|---|
| Gillette Children's Healthcare Outreach-DME | Doing Business As Name - Organization |
| Street Address |
435 PHALEN BLVD GILLETTE LIFETIME SPECIALITY HEALTHCARE |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55101-5302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740720812 | Nicole Renee Hoisser | Nurse Practitioner | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2017-03-08 |
| 1922548809 | Amy Jo Porter | Specialist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2017-02-27 |
| 1285186619 | Katherine Jonas | Physician Assistant | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-11-02 |
| 1316491970 | Angela Kezar | Occupational Therapist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-08-11 |
| 1760833446 | Marie-pier Winters | Physical Therapist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-06-24 |
| 1376904698 | Michaelen Elise Sundstrom | Physical Therapist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-03-14 |
| 1932568524 | Lindsay Knight | Specialist/Technologist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-02-11 |
| 1134594310 | Dawn Babcock | Nurse Practitioner | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2015-12-14 |
| 1750767158 | Leonardo E Candelario Perez | Psychologist | 435 Phalen Blvd, Saint Paul, MN 55130 | 2015-08-07 |
| 1487030490 | Clinton Mccullough | Specialist/Technologist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2015-08-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508480427 | El Solutions LLC | Clinic/Center | 445 Minnesota St., Ste. 1500 12, St. Paul, MN 55101 | 2020-06-05 |
| 1689211443 | Siripa Min | Nurse Anesthetist, Certified Registered | 640 Jackson Street Mail Stop 11503, St. Paul, MN 55101 | 2019-11-28 |
| 1922590488 | Diane Mcleod | Physician Assistant | Healthpartners Regions Specialty Clinics, 640 Jackson St - Mail Stop 11109e, Saint Paul, MN 55101 | 2018-05-31 |
| 1699284919 | Eric Mcgillis | Emergency Medicine | Regions Hospital - Emergency Medicine, 11102f, 640 Jackson St, St Paul, MN 55101 | 2017-09-29 |
| 1073051751 | Hannah Elizabeth Rosenthal Danielson | Physician Assistant | 640 Jackson St # Ms 11102m, Saint Paul, MN 55101 | 2017-02-02 |
| 1992182323 | Theresa Annette Cashdollar-powell | Social Worker | 640 Jackson, St Paul, MN 55101 | 2015-05-06 |
| 1770986101 | Margaret Augusta Cutter | Physician Assistant | 200 Univeristy Ave E, Saint Paul, MN 55101 | 2014-09-30 |
| 1851641419 | Lisa Rae Caturia | Occupational Therapy Assistant | 640 Jackson St, 8th Floor, St Paul, MN 55101 | 2012-09-11 |
| 1558619478 | Rph On The Go | Community/Behavioral Health | 172 E 6th Street, 704, Saint Paul, MN 55101 | 2012-08-27 |
| 1184994212 | Duyen Truong | Pharmacist | 604 Jackson Street, St. Paul, MN 55101 | 2012-01-05 |
| Find all providers in zip 55101 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760998165 | Abilitech Medical, Inc. | Prosthetic/Orthotic Supplier | 628 Pine St, Saint Paul, MN 55130-4421 | 2017-12-20 |
| 1659346195 | Actra Rehabilitation Associates, Inc. | Prosthetic/Orthotic Supplier | 2032 Marshall Ave, Saint Paul, MN 55104-5744 | 2006-02-20 |
| 1487080974 | Orthotic Care Services LLP | Prosthetic/Orthotic Supplier | 310 Smith Ave N, Ste 430, Saint Paul, MN 55102-2393 | 2013-09-17 |
| 1104163187 | Westlake Orthotics and Prosthetics Inc | Prosthetic/Orthotic Supplier | 360 Sherman St, Suite 160, Saint Paul, MN 55102-2564 | 2013-01-10 |
| 1932228632 | Eric Allen Kroll | Prosthetic/Orthotic Supplier | 2200 University Ave W, Suite #114, Saint Paul, MN 55114-1839 | 2007-03-27 |
| 1508873464 | Fairview Health Services | Prosthetic/Orthotic Supplier | 2200 University Ave W, Ste 114, Saint Paul, MN 55114-1839 | 2006-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578648 | Kanika Lanese Baker | Prosthetic/Orthotic Supplier | 7240 Brooklyn Blvd Ste 150, Brooklyn Park, MN 55429-1274 | 2020-11-05 |
| 1932758067 | David Allen Young | Prosthetic/Orthotic Supplier | 1163 Wayzata Blvd E, Wayzata, MN 55391-1935 | 2019-09-11 |
| 1073080230 | Rebound Orthotics & Prosthetics, Inc. | Prosthetic/Orthotic Supplier | 2805 Campus Dr Ste 101, Plymouth, MN 55441-2676 | 2018-10-25 |
| 1003351990 | Arise Orthotics & Prosthetics, Inc. | Prosthetic/Orthotic Supplier | 8338 Highway 65 Ne, Suite E, Spring Lake Park, MN 55432-1364 | 2016-12-30 |
| 1073065298 | Language of Hair | Prosthetic/Orthotic Supplier | 1615 London Rd, Duluth, MN 55812-1620 | 2016-11-04 |
| 1275900664 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 12401 Wayzata Blvd, Minnetonka, MN 55305-1974 | 2015-09-01 |
| 1326483264 | Prosthetic Specialties LLC | Prosthetic/Orthotic Supplier | 13143 Lake Place Rd, Zimmerman, MN 55398-9567 | 2013-05-06 |
| 1427300706 | Rebound Orthotics & Prosthetics, Inc. | Prosthetic/Orthotic Supplier | 1073 Highway 15 S, Plaza 15, Hutchinson, MN 55350-3153 | 2012-10-10 |
| 1033461322 | Rebound Orthotics & Prosthetics, Inc. | Prosthetic/Orthotic Supplier | 300 Catlin St Ste 104, Buffalo, MN 55313-2035 | 2012-10-10 |
| 1487913554 | Otto Bock Healthcare Lp | Prosthetic/Orthotic Supplier | 14800 28th Ave N, Suite 110-d, Minneapolis, MN 55447-4873 | 2012-05-10 |
| Find all providers with the same taxonomy | ||||
| City | SAINT PAUL |
| Zip Code | 55101 |
Please comment or provide details below to improve the information on GILLETTE CHILDREN'S SPECILATY HEALTHCARE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.