Provider Demographics
NPI:1588663215
Name:GREATER LANSING ORTHOTIC CLINIC INC.
Entity type:Organization
Organization Name:GREATER LANSING ORTHOTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLISOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-337-0300
Mailing Address - Street 1:200 N. HOMER
Mailing Address - Street 2:SUITE C
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912
Mailing Address - Country:US
Mailing Address - Phone:517-337-0300
Mailing Address - Fax:517-337-2262
Practice Address - Street 1:200 N. HOMER
Practice Address - Street 2:SUITE C
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:517-337-0300
Practice Address - Fax:517-337-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0733290001Medicare NSC