HEAVENLY FIT LLC (NPI# 1073523981) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073523981 |
| Entity Type | Organization |
| Organization Name | HEAVENLY FIT LLC |
| Practice Address |
545 Skyhawk Ave Campbellsport WI 53010-3055 |
| Practice Telephone | 9205333050 |
| Practice Fax Number | 9205333052 |
| Mailing Telephone | 9205333050 |
| Mailing Fax Number | 9205333052 |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2008-03-31 |
| Authorized Official Name | JEFFREY SCOTT MC CALLUM (OWNER) |
| Authorized Official Telephone | 9205333050 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| Street Address |
545 SKYHAWK AVE |
| City | CAMPBELLSPORT |
| State | WI |
| Zip Code | 53010-3055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962763904 | Amanda Marie Murphy | Licensed Practical Nurse | W3617 Saint Kilian Drive, Campbellsport, WI 53010 | 2012-06-06 |
| 1144513110 | Trisha Jo Pieper | Registered Nurse | W2789 Cty Rd F, Campbellsport, WI 53010 | 2011-05-24 |
| 1154557817 | Schlaefer Optometrists | Clinic/Center | 128 W Main St., Campbellsport, WI 53010 | 2009-06-08 |
| 1639237019 | Aurora Pharmacy, Inc. | Pharmacy | 470 Grand View Avenue, Suite 1, Campbellsport, WI 53010 | 2006-12-05 |
| 1265546600 | Village of Campbellsport | Ambulance | 548 E Main St, Campbellsport, WI 53010 | 2006-08-19 |
| 1083627491 | Jeanne Marie Russart | Licensed Practical Nurse | N1495 Willow Lane, Jeanne Russart, Campbellsport, WI 53010 | 2006-08-15 |
| 1275675217 | Consultants Laboratory of Wi, LLC | Clinical Medical Laboratory | 350 E Sheboygan St, Campbellsport, WI 53010 | 2007-02-13 |
| 1881784932 | Dean William Uelmen | Dentist | 206 N Helena St., Campbellsport, WI 53010-0609 | 2006-10-12 |
| 1972649952 | Ronald Moos | Dentist | 130 N Fond Du Lac Ave, Campbellsport, WI 53010-0739 | 2007-01-29 |
| 1114327822 | Kathleen Diane Depies | Registered Nurse | N4539 Mulletview Rd, Campbellsport, WI 53010-1442 | 2014-08-29 |
| Find all providers in zip 53010 | ||||
| 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 |
|---|---|---|---|---|
| 1255932604 | Cassie Mae Mathis | Prosthetic/Orthotic Supplier | W1643 Greiner Rd, Freedom, WI 54130-7943 | 2020-11-03 |
| 1649648973 | Nordstrom | Prosthetic/Orthotic Supplier | 2424 N Mayfair Rd, Wauwatosa, WI 53226-1410 | 2015-09-03 |
| 1841698834 | Srt Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 5220 S 27th St., Milwaukee, WI 53221 | 2014-12-08 |
| 1285908624 | Reichert Prosthetics & Orthotics, LLC | Prosthetic/Orthotic Supplier | 5027 Green Bay Rd Ste 124, Kenosha, WI 53144-1771 | 2012-03-02 |
| 1073807475 | Ralph's Shoes | Prosthetic/Orthotic Supplier | 336 Water St, Eau Claire, WI 54703-6132 | 2011-06-02 |
| 1982904769 | Better Balance LLC | Prosthetic/Orthotic Supplier | 2629 E Clairemont Ave, Eau Claire, WI 54701-6726 | 2010-10-27 |
| 1861718744 | Ripon Medical Center | Prosthetic/Orthotic Supplier | 165 W Huron St, Berlin, WI 54923-1590 | 2010-04-16 |
| 1225352172 | Hickok Rehab Services LLC | Prosthetic/Orthotic Supplier | 314 N Washington St, Thorp, WI 54771-9531 | 2010-03-22 |
| 1376866954 | Hickok Rehab Services LLC | Prosthetic/Orthotic Supplier | 831 Dallas St, Chetek, WI 54728-5811 | 2010-03-10 |
| 1124356993 | Natural Tresses LLC | Prosthetic/Orthotic Supplier | 2011 N Richmond St, Appleton, WI 54911-2771 | 2009-12-05 |
| Find all providers with the same taxonomy | ||||
| City | CAMPBELLSPORT |
| Zip Code | 53010 |
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| 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.