Healthcare Provider Details

I. General information

NPI: 1215076435
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES OF GRAND RAPIDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date: 03/25/2008
Reactivation Date: 09/30/2008

III. Provider practice location address

1111 LEFFINGWELL AVE NE
GRAND RAPIDS MI
49525-6406
US

IV. Provider business mailing address

PO BOX 1347
INDIANAPOLIS IN
46206-1347
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-7101
  • Fax: 616-464-6170
Mailing address:
  • Phone: 616-459-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MURRAY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 616-459-7101