Healthcare Provider Details

I. General information

NPI: 1144210378
Provider Name (Legal Business Name): BIOMATRIX ORTHOPEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 E. BIG BEAVER RD.
TROY MI
48083
US

IV. Provider business mailing address

1116 E. BIG BEAVER RD.
TROY MI
48083
US

V. Phone/Fax

Practice location:
  • Phone: 586-773-1400
  • Fax: 586-773-6062
Mailing address:
  • Phone: 586-773-1400
  • Fax: 586-773-6062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC26313
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCO002312
License Number StateMI

VIII. Authorized Official

Name: MR. JON CHRISTOPHER WILLIAMS
Title or Position: MANAGING PARTNER
Credential:
Phone: 248-470-5486