Provider Demographics
NPI:1508218421
Name:ORTHOPEDIC MEDICAL BUILDING EAST, INC.
Entity Type:Organization
Organization Name:ORTHOPEDIC MEDICAL BUILDING EAST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:LENA
Authorized Official - Last Name:WINCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-595-8800
Mailing Address - Street 1:28671 HOOVER RD
Mailing Address - Street 2:28673 HOOVER ROAD
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4105
Mailing Address - Country:US
Mailing Address - Phone:248-595-8800
Mailing Address - Fax:248-595-5817
Practice Address - Street 1:28671 HOOVER RD
Practice Address - Street 2:28673 HOOVER ROAD
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4105
Practice Address - Country:US
Practice Address - Phone:248-595-8800
Practice Address - Fax:248-595-5817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-02
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty