Basic Information
| Provider Information | |||||||||
| NPI: | 1073029211 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST JOSEPH MERCY HOSPITAL | ||||||||
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| OtherOrganizationName: | ST JOSEPH MERCY CANTON CANCER CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34505 W 12 MILE RD | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483313258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343433922 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 S CANTON CENTER RD | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481881992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343988712 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2017 | ||||||||
| LastUpdateDate: | 12/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | GUSHO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SE MI REGIONAL CFO | ||||||||
| AuthorizedOfficialTelephone: | 7343980642 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QI0500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy |
No ID Information.