Organization
FS GRAND RAPIDS SOUTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT L SKINNER JR. C. PED (OWNER)
(616) 698-7200
Entity
Organization
Contact information
Practice address
6750 KALAMAZOO AVE SE, SUITE E, GRAND RAPIDS, MI 49508-7897
(616) 698-7200
(616) 698-7212
Mailing address
6750 KALAMAZOO AVE SE, SUITE E, GRAND RAPIDS, MI 49508-7897
(616) 698-7200
(616) 698-7212
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CPED3413
MI
335E00000X
Prosthetic/Orthotic Supplier
CPED3429
MI
Other
Enumeration date
10/19/2010
Last updated
10/19/2010
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