Provider Demographics
NPI:1699975896
Name:GREATER FLINT PROSTHETIC CENTER
Entity type:Organization
Organization Name:GREATER FLINT PROSTHETIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:WINDSOR
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:810-720-2555
Mailing Address - Street 1:2255 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5417
Mailing Address - Country:US
Mailing Address - Phone:810-720-2555
Mailing Address - Fax:810-720-2551
Practice Address - Street 1:2255 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5417
Practice Address - Country:US
Practice Address - Phone:810-720-2555
Practice Address - Fax:810-720-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4264132Medicaid
MI85OB50516OtherBLUE CROSS BLUE SHIELD
MI1316470001Medicare NSC