Healthcare Provider Details

I. General information

NPI: 1336926450
Provider Name (Legal Business Name): NORTHERN BRACE COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 E 7TH ST STE 105
AUBURN IN
46706-2533
US

IV. Provider business mailing address

26834 LAWRENCE
CENTER LINE MI
48015-1262
US

V. Phone/Fax

Practice location:
  • Phone: 833-828-4178
  • Fax: 260-529-1806
Mailing address:
  • Phone: 586-755-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JAMES E BINSON II
Title or Position: OWNER
Credential:
Phone: 586-755-2300