Provider Demographics
NPI:1598783557
Name:TETER ORTHOTICS & PROSTHETICS, INC
Entity Type:Organization
Organization Name:TETER ORTHOTICS & PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR.
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUMFLEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-947-5701
Mailing Address - Street 1:604 GALEN ST
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-8788
Mailing Address - Country:US
Mailing Address - Phone:989-732-1400
Mailing Address - Fax:989-732-1442
Practice Address - Street 1:604 GALEN ST
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-8788
Practice Address - Country:US
Practice Address - Phone:989-732-1400
Practice Address - Fax:989-732-1442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TETER ORTHOTICS & PROSTHETICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4982513Medicaid
MI0379560017Medicare NSC