Provider Demographics
NPI:1811041460
Name:INTERNATIONAL ORTHOPEDIC SERVICE
Entity Type:Organization
Organization Name:INTERNATIONAL ORTHOPEDIC SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-372-4515
Mailing Address - Street 1:19566 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1915
Mailing Address - Country:US
Mailing Address - Phone:313-372-4515
Mailing Address - Fax:313-521-0137
Practice Address - Street 1:19566 KELLY RD
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1915
Practice Address - Country:US
Practice Address - Phone:313-372-4515
Practice Address - Fax:313-521-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4514790Medicaid
MI4438810001Medicare ID - Type Unspecified