Provider Demographics
NPI:1649592817
Name:PREFERRED VISITING PHYSICIANS, PC
Entity Type:Organization
Organization Name:PREFERRED VISITING PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCELIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODSON
Authorized Official - Suffix:III
Authorized Official - Credentials:PA-C
Authorized Official - Phone:734-968-8682
Mailing Address - Street 1:36500 FORD RD
Mailing Address - Street 2:SUITE 178
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3769
Mailing Address - Country:US
Mailing Address - Phone:734-968-8682
Mailing Address - Fax:734-727-0992
Practice Address - Street 1:36500 FORD RD
Practice Address - Street 2:SUITE 178
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3769
Practice Address - Country:US
Practice Address - Phone:734-968-8682
Practice Address - Fax:734-727-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004396363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty