{
"Npi": {
"NPI": "1750677365",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "COMFORT PROSTHETICS & ORTHOTICS INC",
"ParentOrgTIN": null,
"OrgName": "COMFORT PROSTHETICS & ORTHOTICS INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "276 SOUTHBOUND GRATIOT AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOUNT CLEMENS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48043-2475",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-468-4600",
"MailingAddressFaxNumber": "586-468-9508",
"FirstLinePracticeLocationAddress": "140 S MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "YALE",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48097-3318",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "810-387-4710",
"PracticeLocationAddressFaxNumber": "810-387-4718",
"EnumerationDate": "06/22/2011",
"LastUpdateDate": "04/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MANIERE",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CPO",
"AuthorizedOfficialTelephoneNumber": "586-468-4600",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}