1831140318 NPI number — HENRY FORD MACOMB HOSPITAL WARREN CAMPUS LOBBY PHCY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831140318 NPI number — HENRY FORD MACOMB HOSPITAL WARREN CAMPUS LOBBY PHCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENRY FORD MACOMB HOSPITAL WARREN CAMPUS LOBBY PHCY
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 HOSPITAL WARREN CAMPUS LOBBY PHCY
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:
1831140318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13355 E 10 MILE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48089-2048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-759-7845
Provider Business Mailing Address Fax Number:
586-759-7790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13355 E 10 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48089-2048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-759-7845
Provider Business Practice Location Address Fax Number:
586-759-7790
Provider Enumeration Date:
05/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAYDEN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
586-759-7845

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5301007342 , 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: 2362375 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50012362375 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".