Provider Demographics
NPI:1972555233
Name:WHITNEY HEALTH CARE SERVICES INC
Entity Type:Organization
Organization Name:WHITNEY HEALTH CARE SERVICES INC
Other - Org Name:THE PRESCRIPTION SHOP OF TRAVERSE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-943-0600
Mailing Address - Street 1:404 W COMMERCE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9854
Mailing Address - Country:US
Mailing Address - Phone:231-943-0600
Mailing Address - Fax:231-943-0698
Practice Address - Street 1:4000 EASTERN SKY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7351
Practice Address - Country:US
Practice Address - Phone:231-947-6921
Practice Address - Fax:231-947-4579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301005009332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1975631Medicaid
MI1975631Medicaid