Provider Demographics
NPI:1811933641
Name:HENRY FORD MACOMB HOSPITAL CORPORATION
Entity type:Organization
Organization Name:HENRY FORD MACOMB HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:313-874-8714
Mailing Address - Street 1:13355 EAST 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2048
Mailing Address - Country:US
Mailing Address - Phone:313-874-4633
Mailing Address - Fax:313-874-3943
Practice Address - Street 1:13355 EAST 10 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2048
Practice Address - Country:US
Practice Address - Phone:313-874-4633
Practice Address - Fax:313-874-3943
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRY FORD MACOMB HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-21
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1942399829Medicaid
MI23T047Medicare Oscar/Certification
MI23T204Medicare ID - Type Unspecified