Provider Demographics
NPI:1912066093
Name:ADDISON COMMUNITY PHYSICIANS SERVICE ASSOCIATION
Entity Type:Organization
Organization Name:ADDISON COMMUNITY PHYSICIANS SERVICE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCRIPKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-547-1174
Mailing Address - Street 1:135 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-7914
Mailing Address - Country:US
Mailing Address - Phone:734-547-4900
Mailing Address - Fax:734-547-1161
Practice Address - Street 1:135 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-7914
Practice Address - Country:US
Practice Address - Phone:734-547-4900
Practice Address - Fax:734-547-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H111110OtherBCBS OF MI