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General NPI Number Information
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NPI Number | 1003026709
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE INC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4707 SAINT ANTOINE ST SUITE G20
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City | DETROIT
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State | MI
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Zip | 48201-1427
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Country | US
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Telephone | 800-543-0161
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 44290
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City | DETROIT
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State | MI
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Zip | 48244-0290
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER OF CLAIMS AND TECHNOLOGY
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Name | SABAH VELASCO
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Credential |
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Telephone | 313-966-8467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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