MEDICARE: ST JOSEPH HEALTH ENTERPRISES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	607014700	OTHER	MI	USPS DEPT OF LABOR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	540C50277	OTHER	MI	BLUE CROSS BLUE SHIELD MI
4	32665 GRP#39742	OTHER	MI	COMMUNITY CHOICE OF MI

General Provider Information

NPI Number	:	1528122520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JOSEPH HEALTH ENTERPRISES

Provider Business Mailing Address
First Line	:	200 HEMLOCK ST
Second Line	:	P O BOX 659
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9237
Country	:	US
Telephone Number	:	989-362-8591
Fax Number	:	989-362-6100

Provider Business Practice Location Address
First Line	:	410 W M 55
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9239
Country	:	US
Telephone Number	:	989-362-8591
Fax Number	:	989-362-6100

Authorized Official
Title or Position	:	CFO
Name	:	DONNA SANDFORD
Credential	:
Telephone Number	:	989-362-8591

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	06/21/2018

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Directions to “ST JOSEPH HEALTH ENTERPRISES ” Practice Location

Language	Start Address	Practice Location

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