Organization
PROSTHETIC LABORATORIES OF ROCHESTER INC
Active
Parent organization
GMS OF ROCHESTER, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GMS OF ROCHESTER, INC
Authorized official
RANDY S LACEY (CEO)
(507) 281-5250
Entity
Organization
Contact information
Practice address
1517 N OAK AVE, SUITE B, MARSHFIELD, WI 54449-1301
(715) 384-8030
(715) 384-7818
Mailing address
1517 N OAK AVE, SUITE B, MARSHFIELD, WI 54449-1301
(715) 384-8030
(715) 384-7818
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41790900
—
WI
Enumeration date
11/01/2005
Last updated
04/15/2008
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