Organization
PHYSICIAN SUPPORT SERVICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID J SMITH M.D. (PRESIDENT)
(517) 627-2181
Entity
Organization
Contact information
Practice address
11615 HARTEL RD, SUITE 206, GRAND LEDGE, MI 48837-9165
(517) 627-2181
(517) 622-1242
Mailing address
11615 HARTEL RD, SUITE 206, GRAND LEDGE, MI 48837-9165
(517) 627-2181
(517) 622-1242
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
4301030055
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0802363691
BCBSM PIN
MI
Enumeration date
04/26/2011
Last updated
04/26/2011
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