1568508059 NPI number — HENRY FORD MACOMB HOSPITAL CORPORATION

Table of content: (NPI 1568508059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568508059 NPI number — HENRY FORD MACOMB HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENRY FORD MACOMB HOSPITAL CORPORATION
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:
HENRY FORD MACOMB HEALTH CENTERS - BRUCE TWP./CHESTERFIELD/FRASER
Provider Other Organization Name Type Code:
3
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:
1568508059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43421 GARFIELD RD
Provider Second Line Business Mailing Address:
STE 203
Provider Business Mailing Address City Name:
CLINTON TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48038-1133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-263-2622
Provider Business Mailing Address Fax Number:
586-263-2621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80650 VAN DYKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUCE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-798-6430
Provider Business Practice Location Address Fax Number:
810-798-6436
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RATOWSKI
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PROVIDER AFFAIRS
Authorized Official Telephone Number:
248-703-2003

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083P0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010E063590 . This is a "BC GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 080E063590 . This is a "BC GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700E063590 . This is a "BC GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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