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
MR. MARK A PORTH (CHIEF COMPLIANCE OFFICER)
(616) 356-1916
Entity
Organization
Contact information
Practice address
360 LAFAYETTE AVE SE, SUITE 330, GRAND RAPIDS, MI 49503-4677
(616) 356-1916
(616) 356-1868
Mailing address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 356-1916
(616) 356-1868
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
530D105100
BLUE CROSS UPIN
MI
05
—
874438302
—
MI
Enumeration date
06/28/2006
Last updated
07/21/2022
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