Healthcare Provider Details

I. General information

NPI: 1912066093
Provider Name (Legal Business Name): ADDISON COMMUNITY PHYSICIAN SERVICES ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S PROSPECT ST
YPSILANTI MI
48198-7914
US

IV. Provider business mailing address

135 S PROSPECT ST
YPSILANTI MI
48198-7914
US

V. Phone/Fax

Practice location:
  • Phone: 734-547-4900
  • Fax: 734-547-1161
Mailing address:
  • Phone: 734-547-4900
  • Fax: 734-547-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JOANN K SCRIPKO
Title or Position: PATIENT ACCOUNTS MANAGER
Credential:
Phone: 734-547-1174