MEDICARE: SAINT JOSEPH MERCY LIVINGSTON HOSPITAL

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	208000000X	Pediatrics Physician
2	2080N0001X	Neonatal-Perinatal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110D710000	OTHER	MI	BS BCN NBAS

General Provider Information

NPI Number	:	1356460323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT JOSEPH MERCY LIVINGSTON HOSPITAL

Provider Business Mailing Address
First Line	:	5301 E HURON RIVER DR
Second Line	:	PO BOX 993, MC 69504
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1051
Country	:	US
Telephone Number	:	734-712-3456
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	:	03/28/2007
Last Update Date	:	05/05/2026

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Directions to “SAINT JOSEPH MERCY LIVINGSTON HOSPITAL ” Practice Location

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