Provider Demographics
NPI:1609699842
Name:PREFERRED MEDICAL SERVICES PLLC
Entity type:Organization
Organization Name:PREFERRED MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:ROCELIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODSON
Authorized Official - Suffix:III
Authorized Official - Credentials:PA-C
Authorized Official - Phone:313-305-4210
Mailing Address - Street 1:143 CADYCENTRE UNIT 151
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1119
Mailing Address - Country:US
Mailing Address - Phone:313-850-6549
Mailing Address - Fax:
Practice Address - Street 1:5575 CONNER ST STE 203
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-6401
Practice Address - Country:US
Practice Address - Phone:313-305-4210
Practice Address - Fax:313-305-7336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty