Healthcare Provider Details

I. General information

NPI: 1366884942
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES OF GRAND RAPIDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 BYRON CENTER AVE SW STE 100
WYOMING MI
49519-8607
US

IV. Provider business mailing address

PO BOX 1347
INDIANAPOLIS IN
46206-1347
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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