1144735184 NPI number — ST JOSEPH MERCY HOSPITAL-SMHC

Table of content: (NPI 1144735184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144735184 NPI number — ST JOSEPH MERCY HOSPITAL-SMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST JOSEPH MERCY HOSPITAL-SMHC
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:
Provider Other Organization Name Type Code:
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:
1144735184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34505 W 12 MILE RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48331-3286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-343-3922
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44405 WOODWARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONTIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48341-5023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-858-3456
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUSHO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
SE MI REGIONAL CFO
Authorized Official Telephone Number:
734-398-0642

Provider Taxonomy Codes

  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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