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General NPI Number Information
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NPI Number | 1083746820
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Entity Type | Organization
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Legal Business Name | ST JOHN MEDICAL CENTER MACOMB TOWNSHIP
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 12/03/2010
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Provider Practice Location Address
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Address Line | 17700 23 MILE RD
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City | MACOMB
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State | MI
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Zip | 48044-1154
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Country | US
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Telephone | 586-753-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 28000 DEQUINDRE RD
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City | WARREN
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State | MI
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Zip | 48092-2468
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Country | US
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Telephone | 586-753-0011
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MS. TOMASINE MARX
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Credential |
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Telephone | 313-343-7676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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