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General NPI Number Information
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NPI Number | 1437187804
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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 | 06/28/2006
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 3290 N WELLNESS DR BLDG D SUITE 140
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City | HOLLAND
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State | MI
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Zip | 49424-8023
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Country | US
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Telephone | 616-392-6240
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Fax |
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Provider Business Mailing Address
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Address Line | 3290 N WELLNESS DR BLDG D STE 140
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City | HOLLAND
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State | MI
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Zip | 49424-8023
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Country | US
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Telephone | 616-840-8433
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Fax | 616-840-9504
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Authorized Official
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Title or Position | COMPLIANCE DIRECTOR
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | MI
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Taxonomy #2
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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 | MI
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