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General NPI Number Information
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NPI Number | 1154836195
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Entity Type | Organization
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Legal Business Name | ST MARY MERCY HOSPITAL
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 12/13/2017
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Provider Practice Location Address
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Address Line | 36475 FIVE 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 | 734-655-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 34505 W 12 MILE RD STE 200
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-3286
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Country | US
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Telephone | 734-343-3922
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Fax |
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Authorized Official
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Title or Position | SE MI REGIONAL CFO
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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 | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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