Provider Demographics
NPI:1205059615
Name:MESSER ORTHOPEDICS LLC
Entity type:Organization
Organization Name:MESSER ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MESSER
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:616-447-9000
Mailing Address - Street 1:4955 E BELTLINE DR NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1097
Mailing Address - Country:US
Mailing Address - Phone:616-447-9000
Mailing Address - Fax:616-447-9001
Practice Address - Street 1:4955 E BELTLINE AVE NE
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1097
Practice Address - Country:US
Practice Address - Phone:616-447-9000
Practice Address - Fax:616-447-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO003326335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1205059615Medicaid
MI51-0-D1-1577-0OtherBCBSM
5580460001Medicare NSC