Provider Demographics
NPI:1053331322
Name:HENRY FORD HEALTH SYSTEM
Entity Type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:GREENFIELD HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-642-5038
Mailing Address - Street 1:30100 TELEGRAPH RD
Mailing Address - Street 2:STE 200
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4514
Mailing Address - Country:US
Mailing Address - Phone:248-723-0224
Mailing Address - Fax:248-642-7852
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-7080
Practice Address - Fax:313-916-3123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
09400OtherBLUE CROSS SECONDARY
123051OtherCARE CHOICES
123051OtherPREFERRED CHOICE
08914OtherFEDERAL BLUE CROSS PRIMAR
P08914OtherBLUE CARE NETWORK
08914OtherBLUE CROSS PRIMARY
232505OtherHAP
MI2610401Medicaid
43430OtherGREATLAKES
4808EOtherCAPE
8463770OtherAETNA
09400OtherFEDERAL BLUE CROSS SECOND
14645OtherM CARE
501076OtherULTI MED
102251 0001OtherWELLNESS
8463770OtherAETNA