Provider Demographics
NPI:1306896238
Name:BECKER ORTHOPEDIC APPLIANCE COMPANY
Entity type:Organization
Organization Name:BECKER ORTHOPEDIC APPLIANCE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIGGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-588-7480
Mailing Address - Street 1:635 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4536
Mailing Address - Country:US
Mailing Address - Phone:248-588-7480
Mailing Address - Fax:248-588-6961
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:SUITE E-1225
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2201
Practice Address - Fax:313-916-9491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4379918Medicaid
MI4379918Medicaid
MI0331050007Medicare NSC
MI4379918Medicaid