Provider Demographics
NPI:1528096963
Name:LANSING ORTHOPEDIC PC
Entity type:Organization
Organization Name:LANSING ORTHOPEDIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:RIEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-364-0120
Mailing Address - Street 1:3370 E JOLLY RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-8552
Mailing Address - Country:US
Mailing Address - Phone:517-487-3717
Mailing Address - Fax:517-492-1284
Practice Address - Street 1:3370 E JOLLY RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-487-3717
Practice Address - Fax:517-492-1284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4853350100OtherBCBS OF MICHIGAN
MI0P07220Medicare PIN
MIC36068010Medicare PIN