Provider Demographics
NPI:1447381231
Name:ASCENSION ST JOHN HOSPITAL
Entity Type:Organization
Organization Name:ASCENSION ST JOHN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. - FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALAZZOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-343-3558
Mailing Address - Street 1:28000 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2468
Mailing Address - Country:US
Mailing Address - Phone:586-753-0011
Mailing Address - Fax:
Practice Address - Street 1:21000 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1116
Practice Address - Country:US
Practice Address - Phone:586-753-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI40116OtherBCBSM PIN