Organization
ORTHOTICS GERIATRICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROGER VAN HAAFTEN (PRESIDENT)
(952) 893-9238
Entity
Organization
Contact information
Practice address
2102 CLOVER CT, CHANHASSEN, MN 55317-8353
(952) 893-9238
(952) 831-8405
Mailing address
2102 CLOVER CT, CHANHASSEN, MN 55317-8353
(952) 893-9238
(952) 831-8405
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7G638GE
BLUECROSS BLUESHIELD OF M
FM
Enumeration date
05/09/2006
Last updated
08/22/2020
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