Healthcare Provider Details

I. General information

NPI: 1477509453
Provider Name (Legal Business Name): PHYSICIAN SUPPORT SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 M 119
HARBOR SPRINGS MI
49740
US

IV. Provider business mailing address

8881 M 119
HARBOR SPRINGS MI
49740-9479
US

V. Phone/Fax

Practice location:
  • Phone: 231-347-5400
  • Fax: 231-348-2515
Mailing address:
  • Phone: 231-347-5400
  • Fax: 231-348-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TRICIA LEE MENARD
Title or Position: BILLING OFFICE MANAGER
Credential:
Phone: 231-348-3808