Provider Demographics
NPI:1366696627
Name:NORTHERN PROSTHETICS
Entity type:Organization
Organization Name:NORTHERN PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LAPLANTE
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:207-768-5348
Mailing Address - Street 1:117 ACADEMY STREET
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3000
Mailing Address - Country:US
Mailing Address - Phone:207-768-5348
Mailing Address - Fax:207-540-1337
Practice Address - Street 1:117 ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3000
Practice Address - Country:US
Practice Address - Phone:207-768-5348
Practice Address - Fax:207-540-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME6024660001Medicare NSC