Provider Demographics
NPI:1144210378
Name:BIOMATRIX ORTHOPEDICS LLC
Entity Type:Organization
Organization Name:BIOMATRIX ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-470-5486
Mailing Address - Street 1:1116 E. BIG BEAVER RD.
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:586-773-1400
Mailing Address - Fax:586-773-6062
Practice Address - Street 1:1116 E. BIG BEAVER RD.
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:586-773-1400
Practice Address - Fax:586-773-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
MIC26313335E00000X
MICO002312335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH71514OtherBLUE CROSS BLUE SHIELD
MI540E01784Medicare PIN
MIOH71514OtherBLUE CROSS BLUE SHIELD