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General NPI Number Information
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NPI Number | 1033938345
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Entity Type | Organization
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Legal Business Name | MARY FREE BED ORTHOTICS AND PROSTHETICS
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 430 E LASALLE AVE
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City | SOUTH BEND
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State | IN
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Zip | 46617-2724
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Country | US
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Telephone | 616-840-8007
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Fax |
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Provider Business Mailing Address
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Address Line | 235 WEALTHY ST SE STE 1100
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-5247
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Country | US
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Telephone | 616-840-8007
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | ROBERT TUCK
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Credential | CPO
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Telephone | 616-502-6488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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