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General NPI Number Information
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NPI Number | 1780658443
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Entity Type | Organization
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Legal Business Name | ST JOSEPH MERCY HOSPITAL
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 5301 HURON RIVER DRIVE
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City | YPSILANTI
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State | MI
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Zip | 48197-1051
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Country | US
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Telephone | 734-712-3456
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Fax |
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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 | 734-343-3922
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Fax |
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Authorized Official
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Title or Position | CFO SE MI REGION
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Name | MICHAEL P GUSHO
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Credential |
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Telephone | 231-672-3886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 810030
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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