1306412184 NPI number — TRINITY HEALTH - MICHIGAN

Table of content: (NPI 1306412184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306412184 NPI number — TRINITY HEALTH - MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY HEALTH - MICHIGAN
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 PHARMACY - SCHOOLCRAFT CAMPUS
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:
1306412184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5333 MCAULEY DR STE R6106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48197-1014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-420-4864
Provider Business Mailing Address Fax Number:
734-712-1274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19000 ST. JOE'S PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
LIVONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-743-4646
Provider Business Practice Location Address Fax Number:
734-743-4373
Provider Enumeration Date:
06/02/2021

Additional Information

Authorized Official

Authorized Official Last Name:
RAYMOND
Authorized Official First Name:
ARIANA
Authorized Official Middle Name:
GRACE
Authorized Official Title or Position:
MANAGER, PROVIDER ENROLLMENT
Authorized Official Telephone Number:
734-343-1466

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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