Provider Demographics
NPI:1609921774
Name:ORTHOPAEDIC SPECIALISTS OF MUSKEGON PLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALISTS OF MUSKEGON PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-722-7245
Mailing Address - Street 1:1675 LEAHY ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5500
Mailing Address - Country:US
Mailing Address - Phone:231-722-7245
Mailing Address - Fax:231-722-6103
Practice Address - Street 1:1675 LEAHY ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-722-7245
Practice Address - Fax:231-722-6103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F16382Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER