Healthcare Provider Details

I. General information

NPI: 1740312685
Provider Name (Legal Business Name): ST JOHN HOSPITAL AND MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26755 BALLARD ST
HARRISON TOWNSHIP MI
48045-2419
US

IV. Provider business mailing address

28000 DEQUINDRE RD
WARREN MI
48092-2468
US

V. Phone/Fax

Practice location:
  • Phone: 583-753-0011
  • Fax:
Mailing address:
  • Phone: 586-753-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER J PALAZZOLO
Title or Position: V.P. - FINANCE
Credential:
Phone: 313-343-3558