Provider Demographics
NPI:1396176244
Name:ORTHOTECH APPLIANCE
Entity type:Organization
Organization Name:ORTHOTECH APPLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-343-1270
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-0212
Mailing Address - Country:US
Mailing Address - Phone:989-343-1270
Mailing Address - Fax:989-343-0525
Practice Address - Street 1:4725 WENMAR DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2849
Practice Address - Country:US
Practice Address - Phone:989-791-1680
Practice Address - Fax:989-791-1685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7136350001Medicare NSC