Provider Demographics
NPI:1639368095
Name:COMMUNITY ORTHOPEDIC SURGERY PC
Entity Type:Organization
Organization Name:COMMUNITY ORTHOPEDIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-712-0635
Mailing Address - Street 1:420 W RUSSELL ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1160
Mailing Address - Country:US
Mailing Address - Phone:734-429-1540
Mailing Address - Fax:734-429-1543
Practice Address - Street 1:420 W RUSSELL ST
Practice Address - Street 2:SUITE 109
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1160
Practice Address - Country:US
Practice Address - Phone:734-429-1540
Practice Address - Fax:734-429-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0512370003Medicare NSC