Provider Demographics
NPI:1568508059
Name:HENRY FORD MACOMB HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:HENRY FORD MACOMB HOSPITAL CORPORATION
Other - Org Name:HENRY FORD MACOMB HEALTH CENTERS - BRUCE TWP./CHESTERFIELD/FRASER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROVIDER AFFAIRS
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RATOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-703-2003
Mailing Address - Street 1:43421 GARFIELD RD
Mailing Address - Street 2:STE 203
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1133
Mailing Address - Country:US
Mailing Address - Phone:586-263-2622
Mailing Address - Fax:586-263-2621
Practice Address - Street 1:80650 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:MI
Practice Address - Zip Code:48065
Practice Address - Country:US
Practice Address - Phone:810-798-6430
Practice Address - Fax:810-798-6436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010E063590OtherBC GROUP NUMBER
MI080E063590OtherBC GROUP NUMBER
MI700E063590OtherBC GROUP NUMBER
MI700E063590OtherBC GROUP NUMBER