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General NPI Number Information
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NPI Number | 1649355918
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Entity Type | Organization
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Legal Business Name | ST. JOHN HOSPITAL
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 22101 MOROSS RD
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City | DETROIT
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State | MI
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Zip | 48236-2148
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Country | US
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Telephone | 313-343-6864
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Fax |
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Provider Business Mailing Address
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Address Line | 47630 SONNETT DR
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City | MACOMB
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State | MI
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Zip | 48042-5023
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Country | US
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Telephone | 586-949-0098
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Fax |
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Authorized Official
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Title or Position | CRNA
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Name | STEVE WARNKE
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Credential |
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Telephone | 313-343-6864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 4704134377
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License Number State | MI
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