Healthcare Provider Details

I. General information

NPI: 1184607335
Provider Name (Legal Business Name): MARY FREE BED ORTHOTICS AND PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WEALTHY ST SE STE 1100
GRAND RAPIDS MI
49503-5247
US

IV. Provider business mailing address

235 WEALTHY ST SE STE 1100
GRAND RAPIDS MI
49503-5247
US

V. Phone/Fax

Practice location:
  • Phone: 616-840-8007
  • Fax: 616-840-9752
Mailing address:
  • Phone: 616-840-8007
  • Fax: 616-840-9504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateMI

VIII. Authorized Official

Name: ROBERT TUCK
Title or Position: COMPLIANCE DIRECTOR
Credential: CPO
Phone: 616-502-6488