| Samone Derks Llc | |
|
129 W Baraga Ave Ste F Marquette MI 49855-4761 | |
| (906) 361-1386 | |
| Not Available |
| Full Name | Samone Derks Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 129 W Baraga Ave Ste F, Marquette, Michigan |
| Authorized Official Name and Position | Samone Lynn Derks (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 9063611386 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samone Derks Llc 129 W Baraga Ave Ste F Marquette MI 49855-4761 Ph: (906) 361-1386 | Samone Derks Llc 129 W Baraga Ave Ste F Marquette MI 49855-4761 Ph: (906) 361-1386 |
| NPI Number | 1215542733 |
|---|---|
| Provider Enumeration Date | 09/11/2020 |
| Last Update Date | 11/17/2020 |
| Certification Date | 11/17/2020 |
| Medicare PECOS PAC ID | 9335550524 |
|---|---|
| Medicare Enrollment ID | O20201118003310 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215542733 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Samone L Derks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447768056 PECOS PAC ID: 5294097069 Enrollment ID: I20180315001752 |
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