Organization
ORTHOTIC & PROSTHETIC HEALTH
Active
Other names
O & P Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT E JOHANSEN CO (PRESIDENT)
(218) 847-6767
Entity
Organization
Contact information
Practice address
214 FRONT ST W, DETROIT LAKES, MN 56501-3020
(218) 847-6767
(218) 847-7676
Mailing address
810 S MAPLE ST, WATERTOWN, SD 57201
(605) 886-3272
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CO1105
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431G30R
BCBS
MN
01
—
5026500002
MEDICINE B
MN
05
—
58576100
—
MN
05
—
9162720
—
SD
Enumeration date
08/23/2006
Last updated
08/22/2020
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