1386716520 NPI number — ST. JOHN HOSPITAL AND MEDICAL CENTER

Table of content: (NPI 1386716520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386716520 NPI number — ST. JOHN HOSPITAL AND MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. JOHN HOSPITAL AND MEDICAL CENTER
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:
HARPER FAMILY PRACTICE
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:
1386716520
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19901 E 10 MILE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLAIR SHORES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48080-1069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-777-1277
Provider Business Mailing Address Fax Number:
586-777-0106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19901 E 10 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CLAIR SHORES
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48080-1069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-777-1277
Provider Business Practice Location Address Fax Number:
586-777-0106
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
877-996-9975

Provider Taxonomy Codes

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

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

  • Identifier: CG4134 . This is a "RAILROAD MEDICARE GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P27380 . This is a "MEDICARE GROUP LEGACY #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 080E017710 . This is a "BCBSM GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: CG3113 . This is a "RAILROAD MEDICARE GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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