Provider Demographics
NPI: | 1265486245 |
---|---|
Name: | ASCENSION RIVER DISTRICT HOSPITAL |
Entity Type: | Organization |
Organization Name: | ASCENSION RIVER DISTRICT HOSPITAL |
Other - Org Name: | ST. JOHN RIVER DISTRICT PHYSICIAN PRACTICES |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | VP FINANCE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GUHA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 248-680-8264 |
Mailing Address - Street 1: | 2292 SOLUTION CENTER |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60677-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 248-680-8000 |
Mailing Address - Fax: | 248-292-3852 |
Practice Address - Street 1: | 4100 S RIVER RD |
Practice Address - Street 2: | |
Practice Address - City: | EAST CHINA |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48054-2909 |
Practice Address - Country: | US |
Practice Address - Phone: | 800-848-0202 |
Practice Address - Fax: | 586-226-6949 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-22 |
Last Update Date: | 2023-11-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 207Q00000X, 207QA0000X, 207QA0505X, 207RE0101X, 207RI0200X, 207V00000X, 207VG0400X, 207VM0101X, 207VX0000X, 207Y00000X, 207YP0228X, 207YS0123X, 207YX0007X, 207YX0602X, 207YX0905X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QA0000X | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine | Group - Multi-Specialty |
No | 207QA0505X | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | Group - Multi-Specialty |
No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
No | 207VX0000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | Group - Multi-Specialty |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 207YP0228X | Allopathic & Osteopathic Physicians | Otolaryngology | Pediatric Otolaryngology | Group - Multi-Specialty |
No | 207YS0123X | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | Group - Multi-Specialty |
No | 207YX0007X | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck | Group - Multi-Specialty |
No | 207YX0602X | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngic Allergy | Group - Multi-Specialty |
No | 207YX0905X | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngology/Facial Plastic Surgery | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 700G410560 | Other | BCBSM GROUP NUMBER |
MA | 700G410560 | Other | BCBSM GROUP NUMBER |