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NPI Code Detail

MEDICARE: PHYSICIAN SUPPORT SERVICE, INC.

MEDICARE: PHYSICIAN SUPPORT SERVICE, INC.
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
1261QP2300XPrimary Care Clinic/Center4301030055MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10802363691OTHERMIBCBSM PIN

General Provider Information

NPI Number : 1043501935
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIAN SUPPORT SERVICE, INC.
Provider Business Mailing Address
First Line : 11615 HARTEL RD
Second Line : SUITE 206
City : GRAND LEDGE
State : MI
Zip : 48837-9165
Country : US
Telephone Number : 517-627-2181
Fax Number : 517-622-1242
Provider Business Practice Location Address
First Line : 11615 HARTEL RD
Second Line : SUITE 206
City : GRAND LEDGE
State : MI
Zip : 48837-9165
Country : US
Telephone Number : 517-627-2181
Fax Number : 517-622-1242
Authorized Official
Title or Position : PRESIDENT
Name : DR. DAVID J SMITH
Credential : M.D.
Telephone Number : 517-627-2181
Provider Enumeration Date : 04/26/2011
Last Update Date : 04/26/2011

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Directions to “PHYSICIAN SUPPORT SERVICE, INC. ” Practice Location

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