1801135777 NPI number — HENRY FORD HEALTH SYSTEM

Table of content: (NPI 1801135777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801135777 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:
HENRY FORD - CSI PHARMACY
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:
1801135777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2023
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:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-723-0291
Provider Business Mailing Address Fax Number:
248-642-6094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1414 E MAPLE RD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48083-9935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-648-7221
Provider Business Practice Location Address Fax Number:
313-567-0744
Provider Enumeration Date:
02/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KUS
Authorized Official First Name:
DAN
Authorized Official Middle Name:
Authorized Official Title or Position:
AMBULATORY PHARMACY DISTRECT M
Authorized Official Telephone Number:
248-723-0255

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2138933 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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