Provider Demographics
NPI:1376563767
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 1:14555 LEVAN RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5083
Practice Address - Country:US
Practice Address - Phone:734-591-6409
Practice Address - Fax:734-591-6225
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
43430OtherGREATLAKES
P08919OtherBLUE CARE NETWORK
09408OtherFEDERAL BLUE CROSS SECOND
232505OtherHAP
MI2701364Medicaid
8463770OtherAETNA
102251 001OtherWELLNESS
4808EOtherCAPE
08918OtherBLUE CROSS PRIMARY
123051OtherPREFERRED CHOICE
14645OtherM CARE
501076OtherULTI MED
08918OtherFEDERAL BLUE CROSS PRIMAR
09408OtherBLUE CROSS SECONDARY
123051OtherCARE CHOICES
09408OtherFEDERAL BLUE CROSS SECOND