Healthcare Provider Details

I. General information

NPI: 1538990387
Provider Name (Legal Business Name): SSC ORTHOPEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 EAST BELTLINE AVE NE SUITE B200
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

2770 EAST BELTLINE AVE NE SUITE B200
GRAND RAPIDS MI
49525
US

V. Phone/Fax

Practice location:
  • Phone: 616-317-5969
  • Fax:
Mailing address:
  • Phone: 616-317-5969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN GARRY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 248-719-0388