1174721740 NPI number — SAINT JOSEPH LIVINGSTON HOSPITAL

Table of content: (NPI 1174721740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174721740 NPI number — SAINT JOSEPH LIVINGSTON HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT JOSEPH LIVINGSTON HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRINITY HEALTH - MICHIGAN
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174721740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 BYRON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWELL
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48843-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-545-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 GENOA BUSINESS PARK DR STE 180
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48114-7374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-786-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUSHO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
REGIONAL CFO
Authorized Official Telephone Number:
231-672-3886

Provider Taxonomy Codes

  • Taxonomy code: 276400000X , with the licence number:  470079 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20210 . This is a "BLUE CROSS OP SUB ABUSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".