# NORTH STAR PODIATRIC LABORATORIES INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 1962409995
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1801315650
- **Legal business name:** 1962409995
- **Authorized official:** MRS. TERESA ANN WAGNER CERTIFIED PEDORTHIST (PRESIDENT)
- **Authorized official phone:** (651) 426-9388

## Contact information

- **Practice address:** 7400 LYNDALE AVE S STE 160, RICHFIELD, MN 55423-4142
- **Practice address phone:** (651) 353-5845
- **Practice address fax:** (612) 224-9457
- **Mailing address:** 13419 FENWAY BLVD N STE 101, HUGO, MN 55038-7466
- **Mailing address phone:** (651) 426-9388
- **Mailing address fax:** (651) 426-7450

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 09/13/2017
- **Last updated:** 10/25/2017