Provider Demographics
NPI:1871108217
Name:ACADIAN SUPREME HEALTH SERVICES
Entity type:Organization
Organization Name:ACADIAN SUPREME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/FNP
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:N
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-930-0258
Mailing Address - Street 1:20831 RIDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1137
Mailing Address - Country:US
Mailing Address - Phone:313-930-0258
Mailing Address - Fax:
Practice Address - Street 1:12866 FORT ST
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1060
Practice Address - Country:US
Practice Address - Phone:313-930-0258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty