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General NPI Number Information
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NPI Number | 1063602092
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Entity Type | Organization
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Legal Business Name | ST MARY MERCY HOSPITAL CRNA
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 36475 5 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-1971
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Country | US
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Telephone | 734-655-4800
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Fax | 734-655-1274
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Provider Business Mailing Address
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Address Line | 36475 5 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-1971
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Country | US
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Telephone | 734-655-4800
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Fax | 734-655-1274
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Authorized Official
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Title or Position | CFO
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Name | MICHAEL GUSHO
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Credential |
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Telephone | 248-763-3575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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