MEDICARE: ST JOHN DETROIT RIVERVIEW 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	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1760453492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JOHN DETROIT RIVERVIEW HOSPITAL

Provider Business Mailing Address
First Line	:	28000 DEQUINDRE RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48092-2468
Country	:	US
Telephone Number	:	586-753-0260
Fax Number	:	586-753-0340

Provider Business Practice Location Address
First Line	:	7733 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-3707
Country	:	US
Telephone Number	:	313-499-4000
Fax Number	:

Authorized Official
Title or Position	:	VP FINANCE
Name	:	DAN BABB
Credential	:
Telephone Number	:	313-499-4146

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	08/22/2020

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Directions to “ST JOHN DETROIT RIVERVIEW HOSPITAL ” Practice Location

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