Provider Demographics
NPI:1477509453
Name:PHYSICIAN SUPPORT SERVICES PLLC
Entity Type:Organization
Organization Name:PHYSICIAN SUPPORT SERVICES PLLC
Other - Org Name:LITTLE TRAVERSE PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MENARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-348-3808
Mailing Address - Street 1:8881 M 119
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-9479
Mailing Address - Country:US
Mailing Address - Phone:231-347-5400
Mailing Address - Fax:231-348-2515
Practice Address - Street 1:8881 M 119
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740
Practice Address - Country:US
Practice Address - Phone:231-347-5400
Practice Address - Fax:231-348-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N21790Medicare ID - Type Unspecified