Provider Demographics
NPI:1174874143
Name:NORTHERN ORTHOTICS & PROSTHETICS
Entity type:Organization
Organization Name:NORTHERN ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:906-353-7161
Mailing Address - Street 1:1015 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-8694
Mailing Address - Country:US
Mailing Address - Phone:906-273-2444
Mailing Address - Fax:906-353-7000
Practice Address - Street 1:1015 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-8694
Practice Address - Country:US
Practice Address - Phone:906-273-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier