Provider Demographics
NPI:1598798142
Name:CATHERINE MCAULEY HEALTH SERVICES CORPORATION
Entity Type:Organization
Organization Name:CATHERINE MCAULEY HEALTH SERVICES CORPORATION
Other - Org Name:SAINT JOSEPH MERCY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT PHYSICIAN SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMBOURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-712-7358
Mailing Address - Street 1:5301 MCAULEY DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1051
Mailing Address - Country:US
Mailing Address - Phone:734-712-5733
Mailing Address - Fax:734-712-1164
Practice Address - Street 1:5301 MCAULEY DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1051
Practice Address - Country:US
Practice Address - Phone:734-712-5733
Practice Address - Fax:734-712-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty