NORTH STAR PODIATRIC LABORATORIES INC. (NPI# 1114370087) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114370087 |
| Entity Type | Organization |
| Organization Name | NORTH STAR PODIATRIC LABORATORIES INC. |
| Practice Address |
3105 Broadway N Ste 10 Fargo ND 58102-1454 |
| Mailing Address |
13419 Fenway Blvd N Ste 101 Hugo MN 55038-7466 |
| Practice Telephone | 7012353851 |
| Practice Fax Number | 7012354546 |
| Mailing Telephone | (651) 426-9388 |
| Mailing Fax Number | 6514267450 |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2017-10-25 |
| Authorized Official Name | MRS. TERESA ANN WAGNER (PRESIDENT) |
| Authorized Official Telephone | 6514269388 |
| Authorized Official Credential | CERTIFIED PEDORT |
| Is Organization Subpart | Y |
| Parent Organization Name | NORTH STAR PODIATRIC LABORATORIES INC. |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332BC3200X |
Durable Medical Equipment & Medical Supplies Specialization: Customized Equipment |
Suppliers | ||
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801315650 | North Star Podiatric Laboratories Inc. | Durable Medical Equipment & Medical Supplies | 7400 Lyndale Ave S Ste 160, Richfield, MN 55423-4142 | 2017-09-13 |
| Street Address |
3105 BROADWAY N STE 10 |
| City | FARGO |
| State | ND |
| Zip Code | 58102-1454 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
| Find all providers in zip 58102 | ||||
| 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 |
|---|---|---|---|---|
| 1356606974 | Midwest Eye Laboratories Sioux Falls, LLC | Prosthetic/Orthotic Supplier | 118 Broadway N, Ste 605, Fargo, ND 58102-4950 | 2012-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235644105 | Inspire Beauty LLC | Prosthetic/Orthotic Supplier | 1940 S Broadway Ste 170, Minot, ND 58701-6508 | 2017-12-13 |
| 1770637936 | St Alexius Medical Center | Prosthetic/Orthotic Supplier | 400 Burdick Expy E Ste 201a, Great Plains Rehabilitation Services Minot, Minot, ND 58701-4769 | 2007-01-23 |
| 1033257704 | Altru Health System | Prosthetic/Orthotic Supplier | 1300 S Columbia Rd, Grand Forks, ND 58201-4012 | 2007-02-02 |
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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.