Provider Demographics
NPI:1063413680
Name:OAKLAND ORTHOPEDIC APPLIANCES
Entity type:Organization
Organization Name:OAKLAND ORTHOPEDIC APPLIANCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-893-7544
Mailing Address - Street 1:2465 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7655
Mailing Address - Country:US
Mailing Address - Phone:989-893-7544
Mailing Address - Fax:989-893-6944
Practice Address - Street 1:1866 N US HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730-9418
Practice Address - Country:US
Practice Address - Phone:989-362-5220
Practice Address - Fax:989-362-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI52540OtherABP ADMINISTRATION
MI644OtherNORTHWOOD
MI0984025OtherHEALTH PLUS OF MICHIGAN
MI52540OtherNPN NORTHWOOD
MI52540OtherNPN NORTHWOOD