Provider Demographics
NPI:1659391043
Name:HENRY FORD HEALTH SYSTEM
Entity Type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:GREENFIELD HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-642-5038
Mailing Address - Street 1:30100 TELEGRAPH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4516
Mailing Address - Country:US
Mailing Address - Phone:248-723-0224
Mailing Address - Fax:248-642-7852
Practice Address - Street 1:44200 WOODWARD AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5045
Practice Address - Country:US
Practice Address - Phone:248-322-7253
Practice Address - Fax:248-322-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
08923OtherBLUE CROSS PRIMARY
08923OtherFEDERAL BLUE CROSS PRIMAR
232505OtherHAP
09409OtherBLUE CROSS SECONDARY
501076OtherULTI MED
P08923OtherBLUE CARE NETWORK
14645OtherMCARE
8463770OtherAETNA
MI2726819Medicaid
1022510001OtherWELLNESS
09409OtherFEDERAL BLUE CROSS SECOND
123051OtherCARE CHOICES
43430OtherGREATLAKES
123051OtherPREFERRED CHOICE
43430OtherGREATLAKES