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General NPI Number Information
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NPI Number | 1265397186
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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 | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 4020 E BELTLINE AVE NE STE 102
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9324
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Country | US
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Telephone | 616-840-8007
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Fax | 616-840-9602
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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 | 616-840-9602
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Authorized Official
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Title or Position | REVENUE CYCLE LEAD, CONTRACT COORD.
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Name | SANDRA G BAKER
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Credential |
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Telephone | 616-840-8552
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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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