Organization
MARY FREE BED ORTHOTICS AND PROSTHETICS
Active
Other names
MARY FREE BED BRACE AND CORSET SHOP
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT TUCK CPO (COMPLIANCE DIRECTOR)
(616) 502-6488
Entity
Organization
Contact information
Practice address
235 WEALTHY ST SE, STE 1100, GRAND RAPIDS, MI 49503-5247
(616) 840-8007
(616) 840-9752
Mailing address
235 WEALTHY ST SE, STE 1100, GRAND RAPIDS, MI 49503-5247
(616) 840-8007
(616) 840-9504
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
530D105100
BLUE CROSS UPIN
MI
05
—
851722744
—
MI
Enumeration date
11/22/2005
Last updated
11/13/2025
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