Provider Demographics
NPI:1568630077
Name:ST MARY MERCY PHYSICIAN PRACTICES
Entity Type:Organization
Organization Name:ST MARY MERCY PHYSICIAN PRACTICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-655-1610
Mailing Address - Street 1:20555 VICTOR PKWY
Mailing Address - Street 2:ATTN: SE MI SHARED SERVICESW3D CHETRINITY HEALTH
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-7031
Mailing Address - Country:US
Mailing Address - Phone:734-343-0282
Mailing Address - Fax:248-380-4445
Practice Address - Street 1:36475 5 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1971
Practice Address - Country:US
Practice Address - Phone:734-655-4800
Practice Address - Fax:734-655-2609
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARY MERCY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-19
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010H233560OtherBCBS-MI PIN
MI010H233560OtherBCBS-MI PIN