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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 320, 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
335E00000X
Prosthetic/Orthotic Supplier
Primary
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
530D105100
BLUE CROSS UPIN
MI
05
853222011
MI
Enumeration date
05/17/2006
Last updated
07/21/2022
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