Provider Demographics
NPI:1376607366
Name:ST JOSEPH HEALTH ENTERPRISES
Entity Type:Organization
Organization Name:ST JOSEPH HEALTH ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-362-8591
Mailing Address - Street 1:200 HEMLOCK ST
Mailing Address - Street 2:PO BOX 659
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9237
Mailing Address - Country:US
Mailing Address - Phone:989-362-8591
Mailing Address - Fax:989-362-6100
Practice Address - Street 1:301 S STATE ST
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-1636
Practice Address - Country:US
Practice Address - Phone:989-362-8591
Practice Address - Fax:989-362-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540C50277OtherBLUE CROSS BLUE SHIELD MI
MI607014700OtherUSPS DEPT OF LABOR
MI4882035Medicaid
MI4882035Medicaid
MI607014700OtherUSPS DEPT OF LABOR