Provider Demographics
NPI:1225042963
Name:OAKWOOD HEALTHCARE, INC.
Entity Type:Organization
Organization Name:OAKWOOD HEALTHCARE, INC.
Other - Org Name:BEAUMONT HOSPITAL - WAYNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT SHARED SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:947-522-3338
Mailing Address - Street 1:26901 BEAUMONT BLVD.
Mailing Address - Street 2:COMPLIANCE
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-4716
Mailing Address - Country:US
Mailing Address - Phone:947-522-1963
Mailing Address - Fax:
Practice Address - Street 1:33155 ANNAPOLIS ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2405
Practice Address - Country:US
Practice Address - Phone:734-467-4000
Practice Address - Fax:734-467-4017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKWOOD HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8200102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q24603OtherBSHIELD/BCN
MI110242923OtherRAIL ROAD PROFESSIONAL
MI000000001928OtherCAPE HEALTH PROFESSIONAL
MI102788722Medicaid
MIOP821157OtherM-CARE PROFESSIONAL
MI0Q24603OtherBSHIELD/BCN