NPIMap

Organization Active NPI

Mary Free Bed Orthotics and Prosthetics

  • Prosthetic/Orthotic Supplier
  • Grand Rapids, MI
National Provider Identifier
1619929643
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
MARY FREE BED ORTHOTICS AND PROSTHETICS
Practice address
360 Lafayette Ave SE
Suite 320
Grand Rapids, MI 49503-4677
Phone
(616) 356-1916
Fax
(616) 356-1868
NPI assigned
May 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mark A Porth
Title
Chief Compliance Officer
Phone
(616) 356-1916

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X MI Primary

Addresses

Primary practice location

360 Lafayette Ave SE
Suite 320
Grand Rapids, MI 49503-4677

Mailing address

235 Wealthy St SE
Grand Rapids, MI 49503-5247
Phone (616) 356-1916

Other identifiers 2

IdentifierTypeStateIssuer
530D105100OtherMIBLUE CROSS UPIN
853222011MedicaidMI

Other names 1

  • Mary Free Bed Brace and Corset Shop Doing business as

National Provider Directory

National Provider Directory

Locations

360 Lafayette Ave SE
Ste 320
Grand Rapids, MI 49503
Phone (616) 242-0342

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1619929643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 WEALTHY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035247",
            "telephone_number": "616-356-1916",
            "fax_number": "616-356-1868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 LAFAYETTE AVE SE",
            "address_2": "SUITE 320",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034677",
            "telephone_number": "616-356-1916",
            "fax_number": "616-356-1868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY FREE BED ORTHOTICS AND PROSTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PORTH",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "616-356-1916",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS UPIN",
            "identifier": "530D105100",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "853222011",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Free Bed Brace and Corset Shop",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.