Provider Demographics
NPI:1093748642
Name:SAINT JOSEPH MERCY LIVINGSTON HOSPITAL
Entity Type:Organization
Organization Name:SAINT JOSEPH MERCY LIVINGSTON HOSPITAL
Other - Org Name:SAINT JOSEPH MERCY LIVINGSTON HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:REGIONAL VP BUS & SYS DEVEL
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:734-712-5481
Mailing Address - Street 1:620 BYRON RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1002
Mailing Address - Country:US
Mailing Address - Phone:517-545-6000
Mailing Address - Fax:
Practice Address - Street 1:620 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1002
Practice Address - Country:US
Practice Address - Phone:517-545-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI100022OtherCARE CHOICES
MI2661652Medicaid
MI2661616Medicaid
MI00210OtherBLUE CROSS AND BCN
MI230069Medicare Oscar/Certification