Provider Demographics
NPI:1093735482
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:SUITE 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 1:21400 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3216
Practice Address - Country:US
Practice Address - Phone:586-779-8779
Practice Address - Fax:586-779-8153
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
232505OtherHAP
MI3523427Medicaid
501076OtherULTI MED
8463770OtherAETNA
08979OtherFEDERAL BLUE CROSS PRIMAR
09495OtherFEDERAL BLUE CROSS SECOND
102251 0001OtherWELLNESS
123051OtherPREFERRED CHOICE
43430OtherGREATLAKES
09495OtherBLUE CROSS SECONDARY
232505OtherPREFERRED HEALTH PLAN
4808EOtherCAPE
P08979OtherBLUE CARE NETWORK
08979OtherBLUE CROSS PRIMARY
123051OtherCARE CHOICES
14300OtherM CARE
232505OtherHAP