Provider Demographics
NPI:1093765737
Name:BECKER ORTHOPEDIC APPLIANCE COMPANY
Entity Type:Organization
Organization Name:BECKER ORTHOPEDIC APPLIANCE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOUSCANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-588-7480
Mailing Address - Street 1:PO BOX 4840
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-4840
Mailing Address - Country:US
Mailing Address - Phone:248-588-7480
Mailing Address - Fax:248-588-6961
Practice Address - Street 1:19251 MACK AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2893
Practice Address - Country:US
Practice Address - Phone:313-640-7750
Practice Address - Fax:313-640-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI58003OtherNPN PROVIDER NUMBER
MI4370206Medicaid
MI100106OtherCARE CHOICES PROVIDER #
MI100106OtherCARE CHOICES PROVIDER #