Provider Demographics
NPI:1164471983
Name:WILLIAM BEAUMONT HOSPITAL
Entity Type:Organization
Organization Name:WILLIAM BEAUMONT HOSPITAL
Other - Org Name:WILLIAM BEAUMONT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR-SHARED SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLBRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:947-522-1911
Mailing Address - Street 1:26901 BEAUMONT BOULEVARD
Mailing Address - Street 2:COMPLIANCE
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1964
Mailing Address - Fax:
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-585-8271
Practice Address - Fax:248-585-8266
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM BEAUMONT HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-09
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N33470Medicare PIN