Provider Demographics
NPI:1770963209
Name:SPARTAN ORTHOTICS AND PROSTHETICS
Entity type:Organization
Organization Name:SPARTAN ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:517-220-4960
Mailing Address - Street 1:2947 EYDE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5373
Mailing Address - Country:US
Mailing Address - Phone:517-220-4960
Mailing Address - Fax:
Practice Address - Street 1:2947 EYDE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5373
Practice Address - Country:US
Practice Address - Phone:517-220-4960
Practice Address - Fax:517-220-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7515980001Medicare Oscar/Certification