Healthcare Provider Details

I. General information

NPI: 1710188842
Provider Name (Legal Business Name): ST GEORGE MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4818 W VERNOR HWY
DETROIT MI
48209-2122
US

IV. Provider business mailing address

4802 W VERNOR HWY
DETROIT MI
48209-2122
US

V. Phone/Fax

Practice location:
  • Phone: 313-843-2500
  • Fax: 313-841-6966
Mailing address:
  • Phone: 313-554-3900
  • Fax: 313-841-6966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GEORGE H ESHO
Title or Position: PRESIDENT
Credential:
Phone: 313-554-3900