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1215930490

NPI Code Detail

MEDICARE: FAMILY ORTHOPEDIC ASSOCIATES P L C

MEDICARE: FAMILY ORTHOPEDIC ASSOCIATES P L C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	4301060979	MI
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	4301059287	MI
3	208100000X	Physical Medicine & Rehabilitation Physician
4	225100000X	Physical Therapist
5	225X00000X	Occupational Therapist
6	225XH1200X	Hand Occupational Therapist
7	332B00000X	Durable Medical Equipment & Medical Supplies
8	363A00000X	Physician Assistant	5601001619	MI
9	207X00000X	Orthopaedic Surgery Physician	4301038287	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0N45090	OTHER	MI	GROUP MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0B51156	OTHER	MI	BCBSM PROVIDER ID #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215930490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY ORTHOPEDIC ASSOCIATES P L C

Provider Business Mailing Address
First Line	:	4466 W BRISTOL RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-3170
Country	:	US
Telephone Number	:	810-733-1200
Fax Number	:	810-733-0688

Provider Business Practice Location Address
First Line	:	4466 W BRISTOL RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-3170
Country	:	US
Telephone Number	:	810-733-1200
Fax Number	:	810-733-0688

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	JENNIFER KELSEY
Credential	:
Telephone Number	:	810-733-1200

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/19/2024

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Directions to “FAMILY ORTHOPEDIC ASSOCIATES P L C ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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