NPIMap

Organization Active NPI

Great Lakes Orthotics & Medical Supply, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Brown Deer, WI
National Provider Identifier
1891373593
Registry record updated Apr 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
GREAT LAKES ORTHOTICS & MEDICAL SUPPLY, INC.
Practice address
3900 W Brown Deer Rd Ste 140
Brown Deer, WI 53209-1220
Phone
(414) 897-8380
Fax
(414) 210-3489
NPI assigned
Apr 1, 2021
Organization subpart
Yes
Parent organization
GREAT LAKES ORTHOTICS & MEDICAL SUPPLY, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 1, 2021

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

Authorized official

Name
Michael Seamus Buggy
Title
President
Phone
(414) 828-9256

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

3900 W Brown Deer Rd Ste 140
Brown Deer, WI 53209-1220

Mailing address

6520 W Layton Ave Ste 103
Greenfield, WI 53220-4500
Phone (414) 897-8380

National Provider Directory

National Provider Directory
Tax ID family
Great Lakes Orthotics and Medical Supply Inc3 organizations share this tax ID, including this one
Part of
Great Lakes Orthotics and Medical Supply Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3900 W Brown Deer Rd
Ste 140
Brown Deer, WI 53209
Phone (414) 771-0500

NPI Registry JSON

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

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617235200000",
    "number": "1891373593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6520 W LAYTON AVE STE 103",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532204500",
            "telephone_number": "414-897-8380",
            "fax_number": "414-210-3489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 W BROWN DEER RD STE 140",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091220",
            "telephone_number": "414-897-8380",
            "fax_number": "414-210-3489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ORTHOTICS & MEDICAL SUPPLY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT LAKES ORTHOTICS & MEDICAL SUPPLY, INC.",
        "enumeration_date": "2021-04-01",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A",
        "authorized_official_last_name": "BUGGY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SEAMUS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-828-9256"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brown Deer, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; 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.