Basic Information
| Provider Information | |||||||||
| NPI: | 1992761985 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST JOSEPH MERCY CHELSEA INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ST. JOSEPH MERCY CHELSEA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 775 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CHELSEA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481181370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345936000 | ||||||||
| FaxNumber: | 7345935365 | ||||||||
| Practice Location | |||||||||
| Address1: | 775 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CHELSEA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481181370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345936000 | ||||||||
| FaxNumber: | 7345935365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 05/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | LOCKARD | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR REIMBURSEMENT MANAGEMENT ANALYST | ||||||||
| AuthorizedOfficialTelephone: | 7343430282 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | MI | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00252 | 01 | MI | MI BLUE CROSS MEDICAL | OTHER | 1558129 | 05 | MI | MEDICAID | 5170317 | 05 | MI | MEDICAID |