1093765737 NPI number — BECKER ORTHOPEDIC APPLIANCE COMPANY

Table of content: (NPI 1093765737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093765737 NPI number — BECKER ORTHOPEDIC APPLIANCE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BECKER ORTHOPEDIC APPLIANCE COMPANY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093765737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4840
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48099-4840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-588-7480
Provider Business Mailing Address Fax Number:
248-588-6961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19251 MACK AVE
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
GROSSE POINTE WOODS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48236-2893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-640-7750
Provider Business Practice Location Address Fax Number:
313-640-7721
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TOUSCANY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
248-588-7480

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 58003 . This is a "NPN PROVIDER NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4370206 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100106 . This is a "CARE CHOICES PROVIDER #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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