Provider Demographics
NPI:1992761985
Name:ST JOSEPH MERCY CHELSEA INC
Entity type:Organization
Organization Name:ST JOSEPH MERCY CHELSEA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR REIMBURSEMENT MANAGEMENT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-398-0642
Mailing Address - Street 1:20555 VICTOR PKWY
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-7031
Mailing Address - Country:US
Mailing Address - Phone:734-593-6000
Mailing Address - Fax:734-593-5365
Practice Address - Street 1:775 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1370
Practice Address - Country:US
Practice Address - Phone:734-593-6000
Practice Address - Fax:734-593-5365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5170317Medicaid
MI00252OtherMI BLUE CROSS MEDICAL
MI1558129Medicaid
MI00252OtherMI BLUE CROSS MEDICAL
MI5170317Medicaid