1104021815 NPI number — TRINITY HEALTH MICHIGAN ANN ARBOR

Table of content: (NPI 1104021815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104021815 NPI number — TRINITY HEALTH MICHIGAN ANN ARBOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY HEALTH MICHIGAN ANN ARBOR
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:
SAINT JOSEPH MERCY HOSPITAL, ANN ARBOR
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:
1104021815
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5301 EAST HURON RIVER DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48106-0995
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-712-5709
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 EAST HURON RIVER DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48106-0995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-712-5709
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOVA
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARAMCY COORDINATOR
Authorized Official Telephone Number:
734-572-2964

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  5301007586 , 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: 5301007586 . This is a "PHARMACY LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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