1376563767 NPI number — HENRY FORD HEALTH SYSTEM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376563767 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:
1376563767
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:
14555 LEVAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48154-5083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-591-6409
Provider Business Practice Location Address Fax Number:
734-591-6225
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: 43430 . This is a "GREATLAKES" identifier . This identifiers is of the category "OTHER".
  • Identifier: P08919 . This is a "BLUE CARE NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09408 . This is a "FEDERAL BLUE CROSS SECOND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 232505 . This is a "HAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2701364 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8463770 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102251 001 . This is a "WELLNESS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4808E . This is a "CAPE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08918 . This is a "BLUE CROSS PRIMARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123051 . This is a "PREFERRED CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14645 . This is a "M CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 501076 . This is a "ULTI MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08918 . This is a "FEDERAL BLUE CROSS PRIMAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09408 . This is a "BLUE CROSS SECONDARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123051 . This is a "CARE CHOICES" identifier . This identifiers is of the category "OTHER".




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