Provider Demographics
NPI:1578601803
Name:ORTHOTECH ORTHOPEDIC APPLIANCE LLC
Entity Type:Organization
Organization Name:ORTHOTECH ORTHOPEDIC APPLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BUGG
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:989-343-0526
Mailing Address - Street 1:2254 S M 30
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-8711
Mailing Address - Country:US
Mailing Address - Phone:989-343-0526
Mailing Address - Fax:989-343-0525
Practice Address - Street 1:2254 S M 30
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-8711
Practice Address - Country:US
Practice Address - Phone:989-343-0526
Practice Address - Fax:989-343-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI530F510320OtherBLUE CROSS
MI4759354Medicaid
MI4759354Medicaid
MI5384480001Medicare ID - Type UnspecifiedMEDICARE