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NPI Code Detail

MEDICARE: ST JOHN HOSPITAL AND MEDICAL CENTER

MEDICARE: ST JOHN HOSPITAL AND MEDICAL CENTER
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
1367500000XCertified Registered Nurse Anesthetist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10E01105OTHERMIBCBSM PIN

General Provider Information

NPI Number : 1740312685
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST JOHN HOSPITAL AND MEDICAL CENTER
Provider Business Mailing Address
First Line : 28000 DEQUINDRE RD
Second Line :
City : WARREN
State : MI
Zip : 48092-2468
Country : US
Telephone Number : 586-753-0011
Fax Number :
Provider Business Practice Location Address
First Line : 26755 BALLARD ST
Second Line :
City : HARRISON TOWNSHIP
State : MI
Zip : 48045-2419
Country : US
Telephone Number : 583-753-0011
Fax Number :
Authorized Official
Title or Position : V.P. - FINANCE
Name : MR. CHRISTOPHER J PALAZZOLO
Credential :
Telephone Number : 313-343-3558
Provider Enumeration Date : 03/09/2007
Last Update Date : 04/22/2010

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Directions to “ST JOHN HOSPITAL AND MEDICAL CENTER ” Practice Location

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