Provider Demographics
NPI:1710188842
Name:ST GEORGE MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:ST GEORGE MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ESHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-554-3900
Mailing Address - Street 1:4802 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2122
Mailing Address - Country:US
Mailing Address - Phone:313-554-3900
Mailing Address - Fax:313-841-6966
Practice Address - Street 1:4818 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2122
Practice Address - Country:US
Practice Address - Phone:313-843-2500
Practice Address - Fax:313-841-6966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty