=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649193947
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOPAEDIC ASSOCIATES OF MUSKEGON, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2026
-----------------------------------------------------
Last Update Date | 08/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1309 S BEACON BLVD
-----------------------------------------------------
City | GRAND HAVEN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49417-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-733-1326
-----------------------------------------------------
Fax | 231-733-5212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 MERCY DR STE 100
-----------------------------------------------------
City | MUSKEGON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49444-1833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-733-1326
-----------------------------------------------------
Fax | 231-733-5212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR REVENUE CYCLE
-----------------------------------------------------
Name | LEISA KIMBROUGH
-----------------------------------------------------
Credential | CPC
-----------------------------------------------------
Telephone | 231-830-2724
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------