Provider Demographics
NPI:1790706901
Name:ST MARY MERCY HOSPITAL
Entity Type:Organization
Organization Name:ST MARY MERCY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEMI REGIONAL CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUSHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-858-6174
Mailing Address - Street 1:36475 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1971
Mailing Address - Country:US
Mailing Address - Phone:734-655-4800
Mailing Address - Fax:734-655-1274
Practice Address - Street 1:36475 5 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1971
Practice Address - Country:US
Practice Address - Phone:734-655-4800
Practice Address - Fax:734-655-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI820190282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4200538Medicaid
MI00243OtherBLUE CROSS ACUTE CARE
MI700H217250OtherBLUE SHIELD PHYSICIAN GRO
MI4200547Medicaid
MI0N12200Medicare PIN
MI4200547Medicaid
MI4200538Medicaid
MI430H217200OtherBLUE SHIELD ANESTHESIA GR
MI0N12200Medicare PIN