Provider Demographics
NPI:1578976437
Name:SETON HEALTH CORPORATION OF SOUTHEASTERN MICHIGAN
Entity Type:Organization
Organization Name:SETON HEALTH CORPORATION OF SOUTHEASTERN MICHIGAN
Other - Org Name:ST. JOHN URGENT CARE - SAMARITAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
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:248-680-8000
Mailing Address - Street 1:PO BOX 17496
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4069
Mailing Address - Country:US
Mailing Address - Phone:248-680-8000
Mailing Address - Fax:248-292-3852
Practice Address - Street 1:5575 CONNER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-6400
Practice Address - Country:US
Practice Address - Phone:313-924-0000
Practice Address - Fax:313-921-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care