Healthcare Provider Details

I. General information

NPI: 1285753236
Provider Name (Legal Business Name): SAINT JOSEPH MERCY LIVINGSTON HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 GRAND RIVER BRIGHTON URGENT CARE
BRIGHTON MI
48114-9309
US

IV. Provider business mailing address

5301 E HURON RIVER DR PO BOX 993, MC 69504
YPSILANTI MI
48197-1051
US

V. Phone/Fax

Practice location:
  • Phone: 810-844-7575
  • Fax:
Mailing address:
  • Phone: 734-712-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PAUL GUSHO
Title or Position: CFO
Credential:
Phone: 231-672-3886