Provider Demographics
NPI:1114061850
Name:CHILDREN'S HOSPITAL OF MICHIGAN
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF MICHIGAN
Other - Org Name:CHILDREN'S HOSPITAL OF MICHIGAN AFTER HOURS URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:VP
Authorized Official - Phone:313-745-0633
Mailing Address - Street 1:3901 BEAUBIEN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:313-745-0633
Mailing Address - Fax:313-745-5395
Practice Address - Street 1:42700 GARFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4201
Practice Address - Country:US
Practice Address - Phone:586-532-3410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care