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NPI Code Detail

MEDICARE: CHILDREN'S AMBULATORY SERVICES, LLC

MEDICARE: CHILDREN'S AMBULATORY SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QS1000XStudent Health Clinic/Center

General Provider Information

NPI Number : 1033253794
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN'S AMBULATORY SERVICES, LLC
Provider Business Mailing Address
First Line : 3901 BEAUBIEN ST
Second Line :
City : DETROIT
State : MI
Zip : 48201-2119
Country : US
Telephone Number : 313-745-0633
Fax Number : 313-745-5395
Provider Business Practice Location Address
First Line : 21431 GRAND RIVER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48219-3801
Country : US
Telephone Number : 313-745-0633
Fax Number : 313-745-0633
Authorized Official
Title or Position : VP FINANCE
Name : MR. JOSEPH SCALLEN
Credential : VP
Telephone Number : 313-745-0633
Provider Enumeration Date : 02/16/2007
Last Update Date : 08/22/2020

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Directions to “CHILDREN'S AMBULATORY SERVICES, LLC ” Practice Location

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