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MARY FREE BED ORTHOTICS AND PROSTHETICS NPI 1619929643


NPI Information

NPI: 1619929643
Provider Name: MARY FREE BED ORTHOTICS AND PROSTHETICS

Doing Business As: MARY FREE BED BRACE AND CORSET SHOP

Classification: Prosthetic/Orthotic Supplier - 335E00000X
Entity Type: Organization
Address:
360 LAFAYETTE AVE SE
SUITE 320
GRAND RAPIDS, MI
ZIP 49503
Phone: (616) 356-1916
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MARY FREE BED ORTHOTICS AND PROSTHETICS is a prosthetic orthotic supplier in Grand Rapids, MI. The provider is an organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. MARY FREE BED ORTHOTICS AND PROSTHETICS NPI is 1619929643. The provider is registered as an organization entity type.
The provider Is Doing Business As Mary Free Bed Brace And Corset Shop.

The provider's business location address is:

360 LAFAYETTE AVE SE
SUITE 320
GRAND RAPIDS, MI
ZIP 49503-677
Phone: (616) 356-1916
Fax: (616) 356-1868

The provider's authorized official is Mark A Porth .
The authorized official title is Chief Compliance Officer and has the following contact phone number (616) 356-1916.

The enumeration date for this NPI number is 5/17/2006 and was last updated on 7/21/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1335E00000XProsthetic/Orthotic SupplierMICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1530D105100OTHERMICHIGANBLUE CROSS UPIN
2853222011MEDICAIDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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