Healthcare Provider Details

I. General information

NPI: 1265535413
Provider Name (Legal Business Name): TRI-COUNTY ORTHOPAEDIC FOOT AND ANKLE CENTER PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 E APPLE AVE
MUSKEGON MI
49442-3759
US

IV. Provider business mailing address

1314 E APPLE AVE
MUSKEGON MI
49442-3759
US

V. Phone/Fax

Practice location:
  • Phone: 231-777-2568
  • Fax: 231-773-4310
Mailing address:
  • Phone: 231-777-2568
  • Fax: 231-773-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD L WOLVERTON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 231-773-4509