GILLETTE CHILDREN'S SPECIALTY HEALTHCARE (NPI# 1194111823) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194111823 |
| Entity Type | Organization |
| Organization Name | GILLETTE CHILDREN'S SPECIALTY HEALTHCARE |
| Practice Address |
1601 Golf Course Rd Grand Rapids MN 55744-8648 |
| 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 | 2015-04-09 |
| Last Update Date | 2015-04-09 |
| 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 |
1601 GOLF COURSE RD |
| City | GRAND RAPIDS |
| State | MN |
| Zip Code | 55744-8648 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326023060 | Jack Victor Carlisle | Family Medicine | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2005-12-14 |
| 1568076602 | Tyler Wesley Waller | Pharmacist | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2020-09-05 |
| 1699397042 | Tiffany Alicia Axtman | Nurse Practitioner | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2020-05-08 |
| 1710511282 | Kelly Manner | Dietitian, Registered | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2020-02-24 |
| 1285273292 | Patrick James Nelson | Physician Assistant | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-12-23 |
| 1801446943 | Natalie Jo Castle | Physician Assistant | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-09-19 |
| 1578121356 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-06-05 |
| 1487210233 | Jake Heggem | Pharmacist | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-05-17 |
| 1902379159 | Grand Itasca Clinic and Hospital | Pharmacy | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-01-09 |
| 1548768534 | Michelle Overbye | Nurse Practitioner | 1601 Golf Course Rd, Grand Rapids, MN 55744 | 2018-01-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710587696 | Friesen & Friesen, Inc | Assisted Living Facility | 1971 Ne 1st Avenue, Grand Rapids, MN 55744 | 2020-10-29 |
| 1699392555 | Duane Stanley Helmer | Counselor | First Call for Help of Itasca County, 1707 Nw 4th Street Suite B, Grand Rapids, MN 55744 | 2020-06-26 |
| 1821631391 | Patrice Marie Curtiss | Technician | 23792 Winckler Road, Grand Rapids, MN 55744 | 2019-10-28 |
| 1578117438 | Christina Marie Hubred | Advanced Practice Dental Therapist | Miskovich Dental Clinic, 1121 Se 4th Avenue, Grand Rapids, MN 55744 | 2019-07-30 |
| 1780081877 | Fcsl Grand Rapids, LLC | Assisted Living Facility | 949 1/2 Sw 11th Street, Grand Rapids, MN 55744 | 2014-12-04 |
| 1912311333 | Doctor V LLC | Psychologist | 2002 Cromell Drive, Hope House of Itasca County, Laprairie, MN 55744 | 2014-06-13 |
| 1104244987 | Linda Reinen-thompson | Contractor | 34307 Hwy. 38, Grand Rapids, MN 55744 | 2014-03-31 |
| 1275883266 | Lana Rae Jacobson | Registered Nurse | 1401 Nw 9th Street, Grand Rapids, MN 55744 | 2012-09-17 |
| 1518252048 | David Allen Griggs | Pharmacist | 2140 S.pokegama Ave., T-0904, Target, Grand Rapids, MN 55744 | 2011-06-13 |
| 1447575063 | Kelly Ann Shermoen | Pharmacist | 18 Se 10th Street, Grand Rapids, MN 55744 | 2010-04-07 |
| Find all providers in zip 55744 | ||||
| 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 |
|---|---|---|---|---|
| 1417460643 | Teter Orthotics & Prosthetics Inc | Prosthetic/Orthotic Supplier | 515 Michigan St Ne Ste 301, Grand Rapids, MI 49503-5721 | 2017-11-09 |
| 1205059615 | Messer Orthopedics LLC | Prosthetic/Orthotic Supplier | 4955 E Beltline Ave Ne, Suite C, Grand Rapids, MI 49525-1097 | 2007-04-11 |
| 1225078298 | Teter Orthotics & Prosthetics, Inc | Prosthetic/Orthotic Supplier | 4024 Park East Ct Se Ste B, Grand Rapids, MI 49546-8810 | 2006-06-07 |
| 1619929643 | Mary Free Bed Orthotics and Prosthetics | Prosthetic/Orthotic Supplier | 360 Lafayette Ave Se, Suite 320, Grand Rapids, MI 49503-4677 | 2006-05-17 |
| 1447230156 | Responsive Home Health Care Inc | Prosthetic/Orthotic Supplier | 1711 4 Mile Rd Ne, Grand Rapids, MI 49525-2440 | 2006-01-19 |
| 1154894046 | Laker Prosthetics | Prosthetic/Orthotic Supplier | 5181 Plainfield Ave Ne, Suite D, Grand Rapids, MI 49525 | 2019-01-03 |
| 1740532035 | Orthopaedic Associates of Grand Rapids PC | Prosthetic/Orthotic Supplier | 2680 Leonard St Ne, Grand Rapids, MI 49525 | 2012-10-10 |
| 1679839146 | Orthopaedic Associates of Grand Rapids, PC | Prosthetic/Orthotic Supplier | 80 68th St Se, Grand Rapids, MI 49548-6980 | 2012-04-09 |
| 1003126400 | Fs Grand Rapids South, LLC | Prosthetic/Orthotic Supplier | 6750 Kalamazoo Ave Se, Suite E, Grand Rapids, MI 49508-7897 | 2010-10-19 |
| 1972737286 | Orthopaedic Associates of Grand Rapids PC | Prosthetic/Orthotic Supplier | 230 Michigan St Ne, Grand Rapids, MI 49503-2550 | 2009-05-14 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 55744 |
Please comment or provide details below to improve the information on GILLETTE CHILDREN'S SPECIALTY HEALTHCARE.
| 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.