Provider Demographics
NPI:1003281072
Name:SETON HEALTH CORPORATION OF SOUTHEASTERN MICHIGAN
Entity Type:Organization
Organization Name:SETON HEALTH CORPORATION OF SOUTHEASTERN MICHIGAN
Other - Org Name:SETON ST CLAIR URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-680-8131
Mailing Address - Street 1:PO BOX 17496
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4069
Mailing Address - Country:US
Mailing Address - Phone:248-680-0800
Mailing Address - Fax:248-292-3852
Practice Address - Street 1:955 FRED MOORE HWY
Practice Address - Street 2:
Practice Address - City:ST CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-4963
Practice Address - Country:US
Practice Address - Phone:248-465-3144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X, 207R00000X, 207RS0012X, 261QU0200X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty