GILLETTE CHILDREN'S SPECIALTY HEALTHCARE (NPI# 1205222833) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205222833 |
| Entity Type | Organization |
| Organization Name | GILLETTE CHILDREN'S SPECIALTY HEALTHCARE |
| Practice Address |
3605 Mayfair Ave Hibbing MN 55746-2935 |
| Mailing Address |
200 University Ave E Patient Accounting Dept, 2nd Floor 435 Phalen Saint Paul MN 55101-2507 |
| Practice Telephone | 6516341938 |
| Mailing Telephone | 6513252177 |
| Mailing Fax Number | 6513252122 |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2015-04-10 |
| Authorized Official Name | JAMES L HADDICAN (VP OF FINANCE/CFO) |
| Authorized Official Telephone | 6513123105 |
| Is Organization Subpart | Y |
| Parent Organization Name | GILLETTE CHILDREN'S SPECIALTY HEALTHCARE |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 332BC3200X |
Durable Medical Equipment & Medical Supplies Specialization: Customized Equipment |
Suppliers | ||
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427557867 | Gillette Children's Specialty Healthcare | Clinic/Center | 505 Paul Bunyan Dr Nw, Bemidji, MN 56601-2400 | 2018-02-11 |
| 1114267093 | Gillette Children's Specialty Healthcare | Clinic/Center | 12400 Whitewater Dr Ste 2030, Minnetonka, MN 55343-4159 | 2013-02-28 |
| 1598068819 | Gillette Children's Specialty Healthcare | Durable Medical Equipment & Medical Supplies | 1303 1st St S Ste 1, Willmar, MN 56201-3493 | 2010-12-08 |
| 1801109012 | Gillette Children's Specialty Healthcare | Prosthetic/Orthotic Supplier | 15860 Audubon Way, Baxter, MN 56401-6943 | 2010-07-16 |
| 1730363698 | Gillette Children's Specialty Healthcare | Durable Medical Equipment & Medical Supplies | 9550 Upland Lane North, Suite 220, Maple Grove, MN 55369 | 2007-12-27 |
| 1225119175 | Gillette Children's Specialty Healthcare | Clinic/Center | 200 East University Ave, St. Paul, MN 55101 | 2006-10-18 |
| 1891319943 | Gillette Children's Specialty Healthcare | Non-Pharmacy Dispensing Site | 200 University Ave E, Saint Paul, MN 55101-2507 | 2020-06-04 |
| 1235639113 | Gillette Children's Specialty Healthcare | Clinic/Center | 300 S Bruce St, Marshall, MN 56258-1934 | 2018-02-16 |
| 1528455128 | Gillette Children's Specialty Healthcare | Durable Medical Equipment & Medical Supplies | 1303 1st St S, Suite 1, Willmar, MN 56201-3492 | 2015-04-21 |
| 1215324983 | Gillette Children's Specialty Healthcare | Durable Medical Equipment & Medical Supplies | 2024 S 6th St, Brainerd, MN 56401-4529 | 2015-04-21 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Gillette Children's Specialty Healthcare | 200 University Avenue East, St. Paul, MN 55101 |
| System for Award Management (SAM) Entities | GILLETTE CHILDREN'S SPECIALTY HEALTHCARE | 200 University Ave E, Saint Paul, MN 55101-2507 |
| Street Address |
3605 MAYFAIR AVE |
| City | HIBBING |
| State | MN |
| Zip Code | 55746-2935 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497740054 | Anastas C Provatas | Internal Medicine | 3605 Mayfair Ave, Hibbing, MN 55746-2935 | 2005-09-20 |
| 1073094850 | Caitlin Leigh Lockard | Physician Assistant | 3605 Mayfair Ave, Hibbing, MN 55746-2935 | 2018-08-28 |
| 1134572092 | Susan Hoyum | Family Medicine | 3605 Mayfair Ave, Hibbing, MN 55746-2935 | 2016-07-15 |
| 1417309873 | Jeanne Marie Antonich | Nurse Practitioner | 3605 Mayfair Ave, Hibbing, MN 55746-2935 | 2016-07-11 |
| 1962860965 | Steven Eldor Breitbarth | Marriage & Family Therapist | 3605 Mayfair Ave, Hibbing, MN 55746-2935 | 2016-02-04 |
| 1992059711 | James C Hooker | Counselor | 3605 Mayfair Ave, Hibbing, MN 55746-2341 | 2012-10-31 |
| 1043569148 | Janean Marie Mccue | Nurse Practitioner | 3605 Mayfair Ave, Fairview Mesaba Clinic, Hibbing, MN 55746 | 2012-09-05 |
| 1003170424 | Dustin Dean Lucarelli | Surgery | 3605 Mayfair Ave, Hibbing, MN 55746-2935 | 2012-06-29 |
| 1952669525 | Kasey Lynn Kapella | Family Medicine | 3605 Mayfair Ave, Hibbing, MN 55746-2935 | 2012-05-02 |
| 1841557022 | Joseph Skaja | Surgery | 3605 Mayfair Ave, Fairview Mesaba Clinic, Hibbing, MN 55746 | 2012-04-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922594753 | Brekke Lee Johnsrud | Dentist | 2020 1st Avenue, Hibbing, MN 55746 | 2018-07-04 |
| 1558751495 | Weston Mark Schmidt | Dental Therapist | 411 East Howard St., Jacobson Family Dentistry PC, Hibbing, MN 55746 | 2015-01-30 |
| 1467870485 | Angela Wivoda | Contractor | 302 East Howard Street, Suite 310, Hibbing, MN 55746 | 2014-04-07 |
| 1871897512 | Nicholas G Ongaro | Chiropractor | 4104 9th Ave W, Hibbing, MN 55746 | 2011-01-10 |
| 1689800153 | Kathleen M Delgreco | Social Worker | 3203 W. 3rd Ave, Hibbing, MN 55746 | 2009-06-10 |
| 1962666461 | Sereen Danielle Sharp | Internal Medicine | 3605 Mayfair Avenue, Hibbing, MN 55746 | 2008-07-14 |
| 1790999274 | Raymond N Sampson | Psychologist | 914 Minnesota St, Hibbing, MN 55746 | 2007-05-10 |
| 1598985517 | Renee Cook | Psychiatry & Neurology | 3203 W. 3rd Ave., Range Mental Health Center-perpich Building, Hibbing, MN 55746 | 2007-05-01 |
| 1841318599 | Nathan Pedersen | Dentist | 802 W 42nd St, Hibbing, MN 55746 | 2007-03-27 |
| 1558406355 | Michael John Quirk | Chiropractor | 1406 East 40th St, Hibbing, MN 55746 | 2007-02-20 |
| Find all providers in zip 55746 | ||||
| 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 |
|---|---|---|---|---|
| 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 |
| 1760998165 | Abilitech Medical, Inc. | Prosthetic/Orthotic Supplier | 628 Pine St, Saint Paul, MN 55130-4421 | 2017-12-20 |
| 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 |
| Find all providers with the same taxonomy | ||||
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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.