Provider Demographics
NPI:1639111057
Name:SAINT MARY'S HEALTH SERVICES
Entity Type:Organization
Organization Name:SAINT MARY'S HEALTH SERVICES
Other - Org Name:MERCY HEALTH SAINT MARY'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-685-6709
Mailing Address - Street 1:1820 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5006
Mailing Address - Country:US
Mailing Address - Phone:616-643-3500
Mailing Address - Fax:616-643-3659
Practice Address - Street 1:200 JEFFERSON AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4502
Practice Address - Country:US
Practice Address - Phone:616-643-3500
Practice Address - Fax:616-643-3659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI410080282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00073OtherMICHIGAN BLUE CROSS
MI1556518Medicaid
MI5712062Medicaid
MI00073OtherMICHIGAN BLUE CROSS