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General NPI Number Information
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NPI Number | 1629741095
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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 | 07/30/2021
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 19000 ST JOES PKWY STE 100
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City | LIVONIA
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State | MI
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Zip | 48152-1477
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Country | US
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Telephone | 734-743-4656
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Fax | 734-743-4369
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Provider Business Mailing Address
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Address Line | 20555 VICTOR PKWY
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City | LIVONIA
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State | MI
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Zip | 48152-7031
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Country | US
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Telephone | 734-343-3925
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Fax | 312-957-3997
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Authorized Official
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Title or Position | REGIONAL CFO
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Name | MICHAEL PAUL 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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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