Healthcare Provider Details

I. General information

NPI: 1013068188
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES OF PORT HURON, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 RIVER CENTRE DR
PORT HURON MI
48060-4463
US

IV. Provider business mailing address

940 RIVER CENTRE DR PO BOX 5031
PORT HURON MI
48060-4463
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-4900
  • Fax: 810-985-3634
Mailing address:
  • Phone: 810-985-4900
  • Fax: 810-985-3634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0519490001
License Number StateMI

VIII. Authorized Official

Name: TODD P MURPHY
Title or Position: PHYSICIAN
Credential: M.D
Phone: 810-985-4900