Provider Demographics
NPI:1689699480
Name:HAGEN ORTHOTICS AND PROSTHETICS
Entity type:Organization
Organization Name:HAGEN ORTHOTICS AND PROSTHETICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:CO, CPED, PTA
Authorized Official - Phone:320-222-3260
Mailing Address - Street 1:306 BECKER AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3341
Mailing Address - Country:US
Mailing Address - Phone:320-222-3260
Mailing Address - Fax:320-222-3262
Practice Address - Street 1:306 BECKER AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3341
Practice Address - Country:US
Practice Address - Phone:320-222-3260
Practice Address - Fax:320-222-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO003977335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN82-00440OtherSELECT CARE
MN360485300Medicaid
MN164933OtherU CARE
MN1041315OtherPREFERRED ONE
MN235L7HAOtherBLUE CROSS BLUE SHEILD
MN82-0040OtherMEDICA
MN99215OtherHEALTH PARTNERS
MN82-0040OtherMEDICA