Provider Demographics
NPI:1295011138
Name:HENRY FORD MEDICAL CENTER COLUMBUS
Entity Type:Organization
Organization Name:HENRY FORD MEDICAL CENTER COLUMBUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC
Authorized Official - Phone:248-344-7380
Mailing Address - Street 1:2457 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2963
Mailing Address - Country:US
Mailing Address - Phone:248-344-7380
Mailing Address - Fax:248-344-6699
Practice Address - Street 1:39450 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3600
Practice Address - Country:US
Practice Address - Phone:248-344-7380
Practice Address - Fax:248-344-6699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRY FORD HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196861261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology