GLACIER PROSTHETIC CARE, INC. (NPI# 1750410825) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750410825 |
| Entity Type | Organization |
| Organization Name | GLACIER PROSTHETIC CARE, INC. |
| Practice Address |
205 Vermeer Dr Suite C Ponderay ID 83852-1660 |
| Mailing Address |
985 N Meridian Rd Kalispell MT 59901-3539 |
| Practice Telephone | 2082554106 |
| Practice Fax Number | 2082554102 |
| Mailing Telephone | 4067553344 |
| Mailing Fax Number | 4067552746 |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2009-11-18 |
| Authorized Official Name | MRS. GINA CARPENTER (VICE PRESIDENT) |
| Authorized Official Telephone | 4067553344 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | 385 | WA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 807555300 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780904474 | Glacier Prosthetic Care, Inc. | Prosthetic/Orthotic Supplier | 1110 W Park Pl, Suite 202, Coeur D Alene, ID 83814-2781 | 2010-06-04 |
| Street Address |
205 VERMEER DR SUITE C |
| City | PONDERAY |
| State | ID |
| Zip Code | 83852-1660 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346606647 | Vern Stairs | Pharmacist | 476999 Us-95, Walmart Supercenter, Ponderay, ID 83852 | 2016-01-04 |
| 1083809727 | Michael R Dibenedetto Md Pllc | Orthopaedic Surgery | 30544 Hwy 200, Ste 102, Ponderay, ID 83852 | 2007-09-06 |
| 1811009988 | David Paul Cox | Dentist | 477542 Hwy 95 N, Ponderay, ID 83852 | 2006-08-31 |
| 1861774291 | Michael David Schicker | Orthopaedic Surgery | 30544 Highway 200 Ste 102, Ponderay, ID 83852 | 2011-09-12 |
| 1083949531 | Mario E Roxas | Naturopath | 476864 Highway 95, Suite #3, Ponderay, ID 83852-5000 | 2009-10-15 |
| 1942716246 | Darwin L Hurst | Family Medicine | 30544 Highway 200 Ste 101, Ponderay, ID 83852-5005 | 2017-12-21 |
| 1902036734 | Innovative Anesthesia | Nurse Anesthetist, Certified Registered | 30544 Highway 200 Ste 201, Pend Oreille Surgery Center, Ponderay, ID 83852-5005 | 2009-07-14 |
| 1255597811 | Travis Lee Taylor | Nurse Practitioner | 30544 Highway 200 Ste 102, Ponderay, ID 83852-5005 | 2008-08-04 |
| 1982741195 | Ryan Leisy | Chiropractor | 30544 Highway 200 Ste 330, Ponderay, ID 83852-5005 | 2007-01-30 |
| 1780651539 | Bruce William Demko | Nurse Anesthetist, Certified Registered | 30544 Highway 200, Ponderay, ID 83852-5005 | 2006-03-01 |
| Find all providers in zip 83852 | ||||
| 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 |
|---|---|---|---|---|
| 1881228591 | Idaho Prosthetics & Orthotics, Inc. | Prosthetic/Orthotic Supplier | 476 Cheney Dr W Ste 160, Twin Falls, ID 83301-3790 | 2020-03-03 |
| 1619508702 | Evergreen Prosthetics and Orthotics, LLC | Prosthetic/Orthotic Supplier | 1500 E Heritage Park St Ste 100, Meridian, ID 83646-5884 | 2020-01-28 |
| 1346803335 | Rehab Systems, Inc. | Prosthetic/Orthotic Supplier | 504 N 10th Ave Ste A, Caldwell, ID 83605-2925 | 2019-04-16 |
| 1588148134 | Dondell Inc. | Prosthetic/Orthotic Supplier | 2102 Caldwell Blvd Ste 116, Nampa, ID 83651-1513 | 2018-09-19 |
| 1598294811 | Ankle Roll Guard, LLC | Prosthetic/Orthotic Supplier | 560 W Ashby Dr, Meridian, ID 83646-4131 | 2017-06-08 |
| 1881126324 | Norco, Inc | Prosthetic/Orthotic Supplier | 163 Thula St Ste 6, Mccall, ID 83638-4429 | 2017-04-03 |
| 1861872269 | Orthopro of Twin Falls, Inc. | Prosthetic/Orthotic Supplier | 1200 Overland Ave, Suite 1, Burley, ID 83318-1867 | 2015-06-02 |
| 1881931319 | Occupational Therapy Unlimited, LLC | Prosthetic/Orthotic Supplier | 30 E Little Ave, Driggs, ID 83422-5138 | 2013-01-03 |
| 1023379377 | Kootenai Prosthetic Orthotic Services Inc | Prosthetic/Orthotic Supplier | 1160 E Polston Ave, Post Falls, ID 83854-6045 | 2012-06-04 |
| 1427375724 | Performance Therapy, LLC | Prosthetic/Orthotic Supplier | 2922 Cortez Ave, Idaho Falls, ID 83404-7554 | 2010-04-26 |
| 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.