Healthcare Provider Details

I. General information

NPI: 1760708945
Provider Name (Legal Business Name): ST JOHN HOSPITAL AND MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28000 DEQUINDRE RD
WARREN MI
48092-2468
US

IV. Provider business mailing address

22101 MOROSS RD
DETROIT MI
48236-2148
US

V. Phone/Fax

Practice location:
  • Phone: 586-753-3000
  • Fax:
Mailing address:
  • Phone: 313-343-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: TOMASINE MARX
Title or Position: CFO
Credential:
Phone: 313-343-7676