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General NPI Number Information
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NPI Number | 1174038111
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Entity Type | Organization
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Legal Business Name | SAINT JOSEPH MERCY LIVINGSTON 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 | 7575 GRAND RIVER RD
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City | BRIGHTON
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State | MI
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Zip | 48114-9309
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Country | US
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Telephone | 810-844-7250
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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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