1144210253 NPI number — ASCENSION PROVIDENCE HOSPITAL

Table of content: (NPI 1144210253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144210253 NPI number — ASCENSION PROVIDENCE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCENSION PROVIDENCE HOSPITAL
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:
1144210253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25925 TELEGRAPH RD
Provider Second Line Business Mailing Address:
STE 210
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48034-2518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-680-8000
Provider Business Mailing Address Fax Number:
248-746-0384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47601 GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48374-1233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-465-4170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DAMSCHRODER
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, VAL BASED ENT & CFO
Authorized Official Telephone Number:
313-876-8452

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100082 . This is a "CARE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HL630006 . This is a "MCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1015800008 . This is a "BOTSFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 934000 . This is a "BEAUMONT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00277 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0061570 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: M004776 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00000001504A . This is a "CAPE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 118635 . This is a "GREAT LAKES" identifier . This identifiers is of the category "OTHER".




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