Provider Demographics
NPI:1720291818
Name:PRESTIGE HEALTH SERVICES PLC
Entity Type:Organization
Organization Name:PRESTIGE HEALTH SERVICES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-362-7100
Mailing Address - Street 1:5400 FORT ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-4632
Mailing Address - Country:US
Mailing Address - Phone:734-362-7100
Mailing Address - Fax:734-671-1768
Practice Address - Street 1:5400 FORT ST
Practice Address - Street 2:SUITE 130
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-4632
Practice Address - Country:US
Practice Address - Phone:734-362-7100
Practice Address - Fax:734-671-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5191916Medicaid
MI110H232900OtherBCN
MI1158215544OtherBCN- INDIVIDUAL
MIE42955OtherHAP
MI110H232900OtherBCBS
MI1158215544OtherBCBS INDIVIDUAL
MI1158215544OtherBCBS INDIVIDUAL