Organization
COMMUNITY ORTHOPEDIC SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA DEE BOLTON (BILLING MANAGER)
(734) 712-0635
Entity
Organization
Contact information
Practice address
5315 ELLIOTT DR, SUITE 202, YPSILANTI, MI 48197-8634
(734) 712-0600
Mailing address
5315 ELLIOTT DR, SUITE 202, YPSILANTI, MI 48197-8634
(734) 712-0600
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0512370004
MEDICARE DMEPOS
MI
Enumeration date
11/15/2007
Last updated
11/15/2007
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