Provider Demographics
NPI:1366486763
Name:DETROIT MACOMB HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:DETROIT MACOMB HOSPITAL CORPORATION
Other - Org Name:ST. JOHN DETROIT RIVERVIEW HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-499-4108
Mailing Address - Street 1:7733 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3707
Mailing Address - Country:US
Mailing Address - Phone:313-499-4254
Mailing Address - Fax:
Practice Address - Street 1:7733 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3707
Practice Address - Country:US
Practice Address - Phone:313-499-4254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAN820023OtherMCARE CRNAS
MI7853578OtherAETNA CRNAS
MIAN820017OtherMCARE ANESTHESIOLOGISTS
MICG7257Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MI0Q26056Medicare ID - Type UnspecifiedANESTHESIOLOGISTS
MI0Q26238Medicare ID - Type UnspecifiedCRNAS