1093735482 NPI number — HENRY FORD HEALTH SYSTEM

Table of content: (NPI 1093735482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093735482 NPI number — HENRY FORD HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENRY FORD HEALTH SYSTEM
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:
6
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:
1093735482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30100 TELEGRAPH RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BINGHAM FARMS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48025-4514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-723-0224
Provider Business Mailing Address Fax Number:
248-642-7852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21400 KELLY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTPOINTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48021-3216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-779-8779
Provider Business Practice Location Address Fax Number:
586-779-8153
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHEPHERD
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
F
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
248-642-5038

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 232505 . This is a "HAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3523427 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 501076 . This is a "ULTI MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8463770 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08979 . This is a "FEDERAL BLUE CROSS PRIMAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09495 . This is a "FEDERAL BLUE CROSS SECOND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102251 0001 . This is a "WELLNESS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123051 . This is a "PREFERRED CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43430 . This is a "GREATLAKES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09495 . This is a "BLUE CROSS SECONDARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 232505 . This is a "PREFERRED HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4808E . This is a "CAPE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P08979 . This is a "BLUE CARE NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08979 . This is a "BLUE CROSS PRIMARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123051 . This is a "CARE CHOICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14300 . This is a "M CARE" identifier . This identifiers is of the category "OTHER".




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