Organization
U.P. DIGESTIVE DISEASE ASSOCIATES. P.C.
Active
Other names
SUPERIOR ENDOSCOPY CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL A LIUBAKKA CPA (PRACTICE ADMINISTRATOR)
(906) 225-3880
Entity
Organization
Contact information
Practice address
1414 W FAIR AVE, SUITE 135, MARQUETTE, MI 49855-5408
(906) 225-3880
(906) 225-4523
Mailing address
1414 W FAIR AVE, SUITE 135, MARQUETTE, MI 49855-5408
(906) 225-3880
(906) 225-4523
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
526811
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40371
BLUE CROSS FACILITY NUMBE
MI
01
—
430003148
RAILROAD MEDICARE
MI
01
—
490E209940
BCBSM PIN NIMBER
MI
Enumeration date
09/29/2006
Last updated
06/14/2012
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