Provider Demographics
NPI:1386913705
Name:ST MARY MERCY HOSPITAL PROFESSIONAL
Entity type:Organization
Organization Name:ST MARY MERCY HOSPITAL PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-655-1610
Mailing Address - Street 1:5301 E HURON RIVER DR
Mailing Address - Street 2:MC 69504
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1051
Mailing Address - Country:US
Mailing Address - Phone:734-827-8883
Mailing Address - Fax:734-827-8822
Practice Address - Street 1:2006 HOGBACK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9750
Practice Address - Country:US
Practice Address - Phone:734-786-2300
Practice Address - Fax:734-786-4915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARY MERCY HOSPITAL PROFESSIONAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-14
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0H10674OtherBCBSM PIN
0P56260Medicare PIN