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General NPI Number Information
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NPI Number | 1740445337
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Entity Type | Organization
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Legal Business Name | ST JOHN HOSPITAL AND MEDICAL CENTER
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 46591 ROMEO PLANK RD SUITE 137
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City | MACOMB
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State | MI
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Zip | 48044-5742
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Country | US
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Telephone | 586-226-6226
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Fax | 586-226-6255
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Provider Business Mailing Address
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Address Line | PO BOX 67000 DEPARTMENT 184101
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City | DETROIT
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State | MI
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Zip | 48267-0002
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Country | US
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Telephone | 877-996-9975
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Fax | 586-228-4533
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Authorized Official
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Title or Position | DIRECTOR
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Name | JENNIFER JOHNSON
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Credential |
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Telephone | 877-996-9975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number |
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology 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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology 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 | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State | MI
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Taxonomy #7
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number |
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License Number State | MI
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Taxonomy #8
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Taxonomy Code | 2471B0102X
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Taxonomy Name | Bone Densitometry Radiologic Technologist
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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 | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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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 | 2471M2300X
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Taxonomy Name | Mammography Radiologic Technologist
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License Number |
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License Number State | MI
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Taxonomy #11
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Taxonomy Code | 2471N0900X
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Taxonomy Name | Nuclear Medicine Technology Radiologic Technologist
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License Number |
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License Number State | MI
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Taxonomy #12
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number |
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License Number State | MI
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Taxonomy #13
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number |
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License Number State | MI
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Taxonomy #14
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | MI
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