Provider Demographics
NPI:1063162071
Name:ADVANCED PROSTHETIC SOLUTIONS
Entity type:Organization
Organization Name:ADVANCED PROSTHETIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:MANIERE
Authorized Official - Suffix:
Authorized Official - Credentials:CP, RRT
Authorized Official - Phone:586-921-4330
Mailing Address - Street 1:2425 S LINDEN RD STE B
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5474
Mailing Address - Country:US
Mailing Address - Phone:586-921-4330
Mailing Address - Fax:
Practice Address - Street 1:2425 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5473
Practice Address - Country:US
Practice Address - Phone:586-921-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
004074OtherABC