1497807333 NPI number — FAMILY ORTHOPEDIC ASSOCIATES P L C

Table of content: (NPI 1497807333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497807333 NPI number — FAMILY ORTHOPEDIC ASSOCIATES P L C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY ORTHOPEDIC ASSOCIATES P L C
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:
ORTHOMICHIGAN/ORTHOMICHIGAN THERAPY SERVICES
Provider Other Organization Name Type Code:
3
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:
1497807333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4466 W BRISTOL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48507-3170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-733-1200
Provider Business Mailing Address Fax Number:
810-733-3130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 S COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAPEER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48446-2514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-667-6110
Provider Business Practice Location Address Fax Number:
810-667-3562
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KELSEY
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
810-733-1200

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XS0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0114X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4578027 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4968819 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4229222 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4527476 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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