Organization
LAND OF LAKES ORTHOTICS & PROSTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARK V POULSON CPO (PROSTHETIST ORTHOTIST)
(952) 745-3004
Entity
Organization
Contact information
Practice address
14395 23RD AVE N, PLYMOUTH, MN 55447-4704
(952) 745-3004
(952) 745-3010
Mailing address
14395 23RD AVE N, PLYMOUTH, MN 55447-4704
(952) 745-3004
(952) 745-3010
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121144
UCARE
MN
05
—
562317100
—
MN
01
—
8200254
MEDICA
MN
Enumeration date
08/15/2005
Last updated
05/26/2011
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us