Provider Demographics
NPI:1265515852
Name:MISSION OBSTETRICS & GYNECOLOGY P C
Entity type:Organization
Organization Name:MISSION OBSTETRICS & GYNECOLOGY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:YERKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-582-9297
Mailing Address - Street 1:11300 E 13 MILE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2500
Mailing Address - Country:US
Mailing Address - Phone:586-574-1313
Mailing Address - Fax:586-574-0842
Practice Address - Street 1:11300 E 13 MILE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2500
Practice Address - Country:US
Practice Address - Phone:586-574-1313
Practice Address - Fax:586-574-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160E010210OtherBCBSM
MI160E010210OtherBCBSM