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General NPI Number Information
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NPI Number | 1124042700
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Entity Type | Organization
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Legal Business Name | MERCY HEALTH PARTNERS SUB-SPECIALTY SERVICES
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 1560 E SHERMAN BLVD STE 250
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City | MUSKEGON
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State | MI
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Zip | 49444-1854
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Country | US
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Telephone | 231-675-8145
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Fax | 231-672-6179
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Provider Business Mailing Address
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Address Line | PO BOX 776982
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City | CHICAGO
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State | IL
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Zip | 60677-1847
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Country | US
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Telephone | 800-494-5797
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MICHAEL GUSHO
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Credential |
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Telephone | 734-398-0642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease 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 | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080S0012X
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Taxonomy Name | Pediatric Sleep Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | MI
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Taxonomy #9
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | MI
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Taxonomy #10
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | MI
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