Basic Information
| Provider Information | |||||||||
| NPI: | 1437176203 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCENSION PROVIDENCE ROCHESTER HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 W UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483071863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486808000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1101 W UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483071863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486525000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 03/31/2020 | ||||||||
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| AuthorizedOfficialLastName: | PALAZZOLO | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 2486525198 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 630070 | MI | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 5170442 | 05 | MI | MEDICAID | 1558094 | 05 | MI | MEDICAID |