1760819718 NPI number — FAMILY ORTHOPEDIC ASSOCIATES, PLC

Table of content: (NPI 1760819718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760819718 NPI number — FAMILY ORTHOPEDIC ASSOCIATES, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY ORTHOPEDIC ASSOCIATES, PLC
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 & MICHIGAN EXTREMITY CARE
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:
1760819718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2023
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:
1537 E HILL RD
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-5190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-603-1100
Provider Business Practice Location Address Fax Number:
810-603-1101
Provider Enumeration Date:
10/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
810-733-1200

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • 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: 332B00000X , with the licence number: 5426420002 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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