Provider Demographics
NPI:1417505322
Name:COMFORT PROSTHETICS & ORTHOTICS, INC
Entity Type:Organization
Organization Name:COMFORT PROSTHETICS & ORTHOTICS, INC
Other - Org Name:COMFORT PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RELMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-468-4600
Mailing Address - Street 1:3221 COMMON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8540
Mailing Address - Country:US
Mailing Address - Phone:586-468-4600
Mailing Address - Fax:586-468-9508
Practice Address - Street 1:3221 COMMON ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8540
Practice Address - Country:US
Practice Address - Phone:586-468-4600
Practice Address - Fax:586-468-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4401572Medicaid
MI0E00967OtherBLUE CROSS BLUE SHEILD OF MICHIGAN