Provider Demographics
NPI:1720018526
Name:COMFORT PROSTHETICS & ORTHOTICS INC
Entity Type:Organization
Organization Name:COMFORT PROSTHETICS & ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MANIERE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:813-801-9110
Mailing Address - Street 1:276 SOUTHBOUND GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2475
Mailing Address - Country:US
Mailing Address - Phone:586-468-4600
Mailing Address - Fax:
Practice Address - Street 1:276 SOUTHBOUND GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2475
Practice Address - Country:US
Practice Address - Phone:586-468-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E00727OtherBLUE CROSS BLUE SHIELD
201442OtherTOTAL HEALTH CARE
MI4401572Medicaid
000000002059OtherCAPE HEALTH PLAN
124937OtherGREAT LAKES HEALTH PLAN
0E00727OtherBLUE CARE NETWORK
124937OtherGREAT LAKES HEALTH PLAN
201442OtherTOTAL HEALTH CARE