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NPI Code Detail

MEDICARE: ST. JOHN MACOMB-OAKLAND HOSPITAL

MEDICARE: ST. JOHN MACOMB-OAKLAND 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
1261QR0200XRadiology Clinic/CenterMI
22085R0202XDiagnostic Radiology PhysicianMI
3261QM1200XMagnetic Resonance Imaging (MRI) Clinic/CenterMI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DA0334OTHERMIRAILROAD MEDICARE GROUP NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1300F301350OTHERMIBCBS GROUP NUMBER

General Provider Information

NPI Number : 1417983990
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. JOHN MACOMB-OAKLAND HOSPITAL
Provider Business Mailing Address
First Line : 43750 GARFIELD RD
Second Line : SUITE 211
City : CLINTON TOWNSHIP
State : MI
Zip : 48038-1135
Country : US
Telephone Number : 586-228-4652
Fax Number : 586-228-4533
Provider Business Practice Location Address
First Line : 27379 DEQUINDRE RD
Second Line :
City : MADISON HEIGHTS
State : MI
Zip : 48071-3487
Country : US
Telephone Number : 248-398-4488
Fax Number : 248-398-4994
Authorized Official
Title or Position : DIRECTOR
Name : MS. JENNIFER JOHNSON
Credential :
Telephone Number : 877-996-9975
Provider Enumeration Date : 06/25/2006
Last Update Date : 01/27/2011

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Directions to “ST. JOHN MACOMB-OAKLAND HOSPITAL ” Practice Location

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