Provider Demographics
NPI:1356316186
Name:DOCTORS SERVICES INC
Entity Type:Organization
Organization Name:DOCTORS SERVICES INC
Other - Org Name:DOCTORS SERVICES PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BALTZER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-627-3002
Mailing Address - Street 1:802 S MAIN ST
Mailing Address - Street 2:STE 3
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-2269
Mailing Address - Country:US
Mailing Address - Phone:231-627-3002
Mailing Address - Fax:231-627-6204
Practice Address - Street 1:802 S MAIN ST
Practice Address - Street 2:STE 3
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2269
Practice Address - Country:US
Practice Address - Phone:231-627-3002
Practice Address - Fax:231-627-6204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-23
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1424279Medicaid
MI1424279Medicaid
E26540Medicare UPIN