NORTH STAR PODIATRIC LAB, INC. (NPI# 1962409995) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962409995 |
| Entity Type | Organization |
| Organization Name | NORTH STAR PODIATRIC LAB, INC. |
| Practice Address |
13419 Fenway Blvd N Suite 101 Hugo MN 55038-7465 |
| Practice Telephone | 6514269388 |
| Practice Fax Number | 6514267450 |
| Mailing Telephone | 6514269388 |
| Mailing Fax Number | 6514267450 |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2020-05-11 |
| Authorized Official Name | MRS. TERRI WAGNER (CERTIFIED PEDORTHIST) |
| Authorized Official Telephone | 6514269388 |
| Authorized Official Credential | CP |
| 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 |
|---|---|---|---|
| FM | MEDICA PROVIDER NUMBER | 8214553 | 01 |
| MN | BLUE CROSS PROVIDER NUMBE | 26569NO | 01 |
| MN | METRO HEALTH PLAN PROV NU | 418173203 | 01 |
| FM | 908817200 | 05 | |
| MN | HEALTH PARTNERS PROVIDER | 66 | 01 |
| Street Address |
13419 FENWAY BLVD N SUITE 101 |
| City | HUGO |
| State | MN |
| Zip Code | 55038-7465 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861948093 | Shanasi Mason | Counselor | 7041 20th Ave S, Centerville, MN 55038 | 2016-08-28 |
| 1982052601 | Patricia Morgan-john | Counselor | 1784 Steven Lane, Centerville, MN 55038 | 2016-06-03 |
| 1811356306 | Drytech Co. LLC | Contractor | 13483 Fenway Blvd Circle No., Hugo, MN 55038 | 2016-02-12 |
| 1750748422 | Lisa Chong Jou | Counselor | 7041 20th Avenue South, Centerville, MN 55038 | 2016-01-26 |
| 1285997577 | William Michael Beeves | Counselor | 7041 20th Avenue S, Centerville, MN 55038 | 2012-06-21 |
| 1720230089 | Healtheast Medical Research Institute | Durable Medical Equipment & Medical Supplies | 14688 Everton Ave., Suite 101, Hugo, MN 55038 | 2008-10-17 |
| 1881868669 | Prili D Gandhi | Family Medicine | 14688 Everton Ave, He Hugo Clinic, Hugo, MN 55038 | 2008-04-14 |
| 1437276763 | Northeast Eye Care of Hugo | Optometrist | 14643 Mercantile Blvd, Suite 112, Hugo, MN 55038 | 2007-03-23 |
| 1134284631 | Hugo Dental Care Pa | Dentist | 5677 147th St N, Hugo, MN 55038 | 2006-12-26 |
| 1023172657 | Sean Patrick Bates | Dentist | 14755 Victor Hugo Blvd, Suite 103, Hugo, MN 55038 | 2006-12-20 |
| Find all providers in zip 55038 | ||||
| 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.