1659499705 NPI number — ST JOSEPH MERCY HOSPITAL

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 1659499705 NPI number — ST JOSEPH MERCY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST JOSEPH MERCY 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:
1659499705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34505 W 12 MILE RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48331-3286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-343-3922
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5333 MCAULEY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 2017
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48197-1096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-434-3200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUSHO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CFO SE MI REGION
Authorized Official Telephone Number:
248-858-6174

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 160H160940 . This is a "BCBSM, BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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