Healthcare Provider Details

I. General information

NPI: 1669567806
Provider Name (Legal Business Name): PHYSICIAN COVERAGE SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 ROBERT T LONGWAY BLVD STE B
FLINT MI
48503-2190
US

IV. Provider business mailing address

2700 ROBERT T LONGWAY BLVD STE B
FLINT MI
48503-2190
US

V. Phone/Fax

Practice location:
  • Phone: 810-235-2004
  • Fax: 810-235-2841
Mailing address:
  • Phone: 810-235-2004
  • Fax: 810-235-2841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. GAIL LYNN KROMER
Title or Position: BILLER
Credential:
Phone: 810-235-2004