MEDICARE: SJMHS ANESTHESIA SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1205271996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SJMHS ANESTHESIA SERVICES

Provider Business Mailing Address
First Line	:	5301 E HURON RIVER DR
Second Line	:	MC 69504
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1051
Country	:	US
Telephone Number	:	734-432-5811
Fax Number	:

Provider Business Practice Location Address
First Line	:	7555 GRAND RIVER RD
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-9338
Country	:	US
Telephone Number	:	810-854-8000
Fax Number	:

Authorized Official
Title or Position	:	MANAGER PROVIDER ENROLLMENT
Name	:	ARIANA GRACE RAYMOND
Credential	:
Telephone Number	:	734-343-1466

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/12/2026

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