Provider Demographics
NPI:1538123963
Name:ASCENSION PROVIDENCE HOSPITAL
Entity Type:Organization
Organization Name:ASCENSION PROVIDENCE HOSPITAL
Other - Org Name:PH FAMILY MEDICINE/PROVIDENCE HOSPTIAL AND MEDICAL CENTERS INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING COODINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-680-8121
Mailing Address - Street 1:3168 SOLUTIONS CENTER BOX 773168
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0001
Mailing Address - Country:US
Mailing Address - Phone:248-680-8000
Mailing Address - Fax:
Practice Address - Street 1:16001 W 9 MILE RD
Practice Address - Street 2:PHYSICIAN BILLING SERVICES
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-849-3000
Practice Address - Fax:248-849-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080F360200OtherMI BLUE CROSS GROUP PIN #
MI080F360200OtherMI BLUE CROSS GROUP PIN #