GILLETTE CHILDREN'S SPECIALTY HEALTHCARE (NPI# 1548656259) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548656259 |
| Entity Type | Organization |
| Organization Name | GILLETTE CHILDREN'S SPECIALTY HEALTHCARE |
| Practice Address |
1705 Anne St Nw Bemidji MN 56601-6151 |
| Mailing Address |
200 University Ave E Saint Paul MN 55101-2507 |
| Practice Telephone | 6516341938 |
| Mailing Telephone | 6513252177 |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2019-10-11 |
| Authorized Official Name | ASHLEY BURCH (CHARGE INTEGRITY MANAGER) |
| Authorized Official Telephone | 6513252111 |
| 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 |
1705 ANNE ST NW |
| City | BEMIDJI |
| State | MN |
| Zip Code | 56601-6151 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780662544 | Delayna A Nitz | Nurse Practitioner | 1705 Anne St Nw, Bemidji, MN 56601-6151 | 2006-01-03 |
| 1609421890 | Christa Vaughan Paramore | Nurse Practitioner | 1705 Anne St Nw, Bemidji, MN 56601-6151 | 2019-08-05 |
| 1043783574 | Hannah Wilson | Counselor | 1705 Anne St Nw, Bemidji, MN 56601-6151 | 2019-01-08 |
| 1043783996 | Kelli Tobin | Dietitian, Registered | 1705 Anne St Nw, Bemidji, MN 56601-6151 | 2019-01-03 |
| 1003392887 | Kayla Joyce Mcclellan | Audiologist | 1705 Anne St Nw, Bemidji, MN 56601-6151 | 2018-07-16 |
| 1205328549 | Katherine Ann Smith | Physician Assistant | 1705 Anne St Nw, Bemidji, MN 56601-6151 | 2018-06-02 |
| 1184136129 | Megan Ann Ludwick | Dietitian, Registered | 1705 Anne St Nw, Bemidji, MN 56601-6151 | 2017-10-31 |
| 1225549132 | Lori Dobson | Social Worker | 1705 Anne St Nw, Bemidji, MN 56601 | 2017-10-18 |
| 1275991952 | Cody Link | Occupational Therapist | 1705 Anne St Nw, Bemidji, MN 56601-6151 | 2016-02-09 |
| 1982077541 | Charly Candas Vangrinsven | Counselor | 1705 Anne St Nw, Bemidji, MN 56601-6151 | 2015-11-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336772425 | Northern Minnesota Addiction Wellness Center | Substance Abuse Rehabilitation Facility | 4851 Stacy Ann Dr Nw, Bemidji, MN 56601 | 2020-02-17 |
| 1366093841 | Vickie Lynn Matthews | Technician | 1018 Miles Ave Se, Bemidji, MN 56601 | 2019-09-25 |
| 1518443530 | Lindsey Marie Whiting | Registered Nurse | 1300 Anne St, Bemidji, MN 56601 | 2018-07-12 |
| 1801257662 | Meghan Zigrida Paquette | Registered Nurse | 6055 161st Street Nw, Cass Lake, MN 56601 | 2016-03-08 |
| 1144686106 | Northwest Indian Oic | Home Health | 1819 Bemidji Ave N Ste 1, Bemidji, MN 56601 | 2016-01-06 |
| 1831560424 | Laura Hansen, Msw, Licsw Counseling Services, Inc. | Social Worker | 403 4th Street Ne, Suite 110, Bemidji, MN 56601 | 2015-10-08 |
| 1679949028 | Grand St. Paul Cvs LLC | Durable Medical Equipment & Medical Supplies | 2312 Bemidji Ave North, Bemidji, MN 56601 | 2015-08-19 |
| 1255717617 | Mary S. Salter, Md Psc | Internal Medicine | 514 Beltrami Ave Nw Suite 102, Bemidji, MN 56601 | 2015-08-07 |
| 1225420615 | Cristin Evans | Counselor | 403 4th Street, Suite 300, Bemidji, MN 56601 | 2015-02-23 |
| 1619367919 | Angela Krom Fournier | Psychologist | 16150 Golden Eagle Court Nw, Eagle Vista Equine Center Inc., Bemidji, MN 56601 | 2015-01-26 |
| Find all providers in zip 56601 | ||||
| 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 |
|---|---|---|---|---|
| 1427234681 | Prosthetic Laboratories of Rochester, Inc | Prosthetic/Orthotic Supplier | 1300 Anne St Nw, Bemidji, MN 56601-5103 | 2008-01-17 |
| 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.