Provider Demographics
NPI:1285654673
Name:HENRY FORD HEALTH SYSTEM
Entity Type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:GREENFIELD HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-642-5038
Mailing Address - Street 1:30100 TELEGRAPH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4514
Mailing Address - Country:US
Mailing Address - Phone:248-723-0224
Mailing Address - Fax:248-642-7852
Practice Address - Street 1:2050 LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1757
Practice Address - Country:US
Practice Address - Phone:248-524-1270
Practice Address - Fax:248-524-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
501076OtherULTI MED
08915OtherBLUE CROSS PRIMARY
P08915OtherBLUE CARE NETWORK
102251 0001OtherWELLNESS
123051OtherCARE CHOICES
4808EOtherCAPE
43430OtherGREATLAKES
08915OtherFEDERAL BLUE CROSS PRIMAR
09403OtherFEDERAL BLUE CROSS SECOND
14645OtherM CARE
09403OtherBLUE CROSS SECONDARY
123051OtherPREFERRED CHOICE
8463770OtherAETNA
232505OtherHAP
MI2610537Medicaid
08915OtherFEDERAL BLUE CROSS PRIMAR