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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 LACEY (CEO)
(507) 536-6100
Entity
Organization

Contact information

Practice address
1300 ANNE ST NW, BEMIDJI, MN 56601-5103
(218) 333-6966
(218) 333-6976
Mailing address
121 23RD AVE SW, ROCHESTER, MN 55902-0998
(507) 281-5250
(507) 288-6928

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
286642000
MN
Enumeration date
01/17/2008
Last updated
09/17/2008
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