GREAT LAKES ORTHOTICS & PROSTHETICS INC. (NPI# 1720023724) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720023724 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES ORTHOTICS & PROSTHETICS INC. |
| Practice Address |
2105 E. Enterprise Ave. Suite 114 Appleton WI 54913 |
| Practice Telephone | 9209682240 |
| Practice Fax Number | 9209682241 |
| Mailing Telephone | 9209682240 |
| Mailing Fax Number | 9209682241 |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2018-12-03 |
| Authorized Official Name | PERRY L ALGER (PRESIDENT) |
| Authorized Official Telephone | 9209682240 |
| Authorized Official Credential | CO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 41792000 | 05 |
| Street Address |
2105 E. ENTERPRISE AVE. SUITE 114 |
| City | APPLETON |
| State | WI |
| Zip Code | 54913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043254162 | Fvosa Surgical Partners, LLC | Clinic/Center | 2105 E. Enterprise Ave., Suite 101, Appleton, WI 54913 | 2006-06-16 |
| 1467702241 | Kara L Brochtrup | Nurse Practitioner | 2105 E. Enterprise Ave., Suite 111, Appleton, WI 54913-7862 | 2012-09-19 |
| 1629218417 | Nicole E. Juedes | Specialist/Technologist, Other | 2105 E. Enterprise Ave., Suite 111, Appleton, WI 54913-7862 | 2009-03-06 |
| 1053578682 | Todd A Derksen | Podiatrist | 2105 E. Enterprise Ave., Suite 111, Appleton, WI 54913-7862 | 2008-05-21 |
| 1811179344 | Eric R. Bowen | Nurse Practitioner | 2105 E. Enterprise Ave., Suite 111, Appleton, WI 54913-7862 | 2007-11-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457994584 | Pamela J Andersen | Music Therapist | 245 N. Metro Drive, Appleton, WI 54913 | 2019-10-22 |
| 1396387510 | Nancy Sibley | Technician | N4423 County Road Ee, Appleton, WI 54913 | 2019-10-09 |
| 1659872240 | Meijer Stores Limited Partnership | Durable Medical Equipment & Medical Supplies | 3801 N. Richmond Street, Grand Chute, WI 54913 | 2018-02-28 |
| 1780116244 | Alison Pelger | Physician Assistant | 3916 North Intertech Court, Appleton, WI 54913 | 2017-04-03 |
| 1316311905 | Lucy Bouressa | Specialist/Technologist | 2105 E. Enterprise Ave, 113, Appleton, WI 54913 | 2015-11-19 |
| 1992189989 | Brittany Reinke | Physical Therapist | Walking and Wheeling, LLC, W4652 Glenn Street, Appleton, WI 54913 | 2015-07-20 |
| 1902280092 | Costco Wholesale Corporation | Pharmacy | 5401 W Integrity Way, Grand Chute, WI 54913 | 2015-07-17 |
| 1942646849 | Richard Anthony Mauthe | Pharmacist | 5401 W. Integrity Way, Neenah, WI 54913 | 2013-05-17 |
| 1750622163 | Tonya Janelle Wilderman | Pharmacist | 1400 N Mccarthy Rd, Apt 2, Grand Chute, WI 54913 | 2013-03-10 |
| 1295938777 | Jenna Marie Kadlec | Physical Therapist | 3916 N. Intertech Court, Appleton, WI 54913 | 2007-06-11 |
| Find all providers in zip 54913 | ||||
| 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 |
|---|---|---|---|---|
| 1124356993 | Natural Tresses LLC | Prosthetic/Orthotic Supplier | 2011 N Richmond St, Appleton, WI 54911-2771 | 2009-12-05 |
| 1861407561 | Vagabond Shoes, Inc. | Prosthetic/Orthotic Supplier | 4760 Integrity Way, Appleton, WI 54913-8464 | 2006-07-30 |
| 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 |
| 1356571509 | Fox River Pedorthics, LLC | Prosthetic/Orthotic Supplier | 222b N Milwaukee St, Waterford, WI 53185-4312 | 2009-07-22 |
| 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.