Provider Demographics
NPI:1528033800
Name:HENRY FORD HEALTH SYSTEM
Entity Type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:HENRY FORD HEALTH PRODUCTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS-CCS
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SLYTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-723-0201
Mailing Address - Street 1:21651 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7906
Mailing Address - Country:US
Mailing Address - Phone:248-353-2468
Mailing Address - Fax:248-353-4206
Practice Address - Street 1:109 PLAZA EAST DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1461
Practice Address - Country:US
Practice Address - Phone:989-345-7090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRY FORD HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-21
Last Update Date:2008-11-05
Deactivation Date:2008-08-14
Deactivation Code:
Reactivation Date:2008-11-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2333OtherHAP
MI540F30281OtherBCBS
MI4962575Medicaid
MI0460850012Medicare ID - Type UnspecifiedPROVIDER NUMBER