Healthcare Provider Details

I. General information

NPI: 1174824643
Provider Name (Legal Business Name): WOLVERINE STATE INPATIENT SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N MCEWAN ST
CLARE MI
48617-1440
US

IV. Provider business mailing address

815 S PALAFOX ST 300
PENSACOLA FL
32502-5960
US

V. Phone/Fax

Practice location:
  • Phone: 214-712-2472
  • Fax: 214-712-2444
Mailing address:
  • Phone: 800-444-7009
  • Fax: 800-305-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS WEBSTER
Title or Position: PRESIDENT
Credential: DO
Phone: 214-712-2000