Provider Demographics
NPI:1245276286
Name:ROSS, MAGGIE ANN (PA)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ANN
Last Name:ROSS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 W SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1504
Mailing Address - Country:US
Mailing Address - Phone:989-463-7181
Mailing Address - Fax:989-463-7351
Practice Address - Street 1:614 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1504
Practice Address - Country:US
Practice Address - Phone:989-463-7181
Practice Address - Fax:989-463-7351
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMR003335363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00717023OtherRAILROAD MEDICARE
MI0852915170OtherBCBSM
MIMI3290001Medicare PIN
MI0852915170OtherBCBSM
MIP14270005Medicare PIN
MIP47670001Medicare PIN