Provider Demographics
| NPI: | 1811044878 |
|---|---|
| Name: | WILLIAM BEAUMONT HOSPITAL |
| Entity Type: | Organization |
| Organization Name: | WILLIAM BEAUMONT HOSPITAL |
| Other - Org Name: | WILLIAM BEAUMONT HOSPITAL |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | SR. DIRECTOR BEAUMONT SHARED SVCS |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | LESLEY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | WILLBRANDT |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 947-522-1911 |
| Mailing Address - Street 1: | 26901 BEAUMONT BLVD |
| Mailing Address - Street 2: | COMPLIANCE |
| Mailing Address - City: | SOUTHFIELD |
| Mailing Address - State: | MI |
| Mailing Address - Zip Code: | 48033-3849 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 947-522-1964 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 3601 W 13 MILE RD |
| Practice Address - Street 2: | |
| Practice Address - City: | ROYAL OAK |
| Practice Address - State: | MI |
| Practice Address - Zip Code: | 48073-6712 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 248-585-8271 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | WILLIAM BEAUMONT HOSPITAL |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2007-01-04 |
| Last Update Date: | 2022-10-12 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RH0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207ZC0006X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology | Group - Multi-Specialty |
| No | 207ZP0101X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MI | 0F364420 | Other | BCBSM |
| MI | 0F349850 | Other | BCBSM |
| MI | 0F359270 | Other | BCBSM |
| MI | 0F36152 | Medicare PIN | |
| MI | 0F359270 | Other | BCBSM |
| MI | 0F36108 | Medicare PIN | |
| MI | 0F36242 | Medicare PIN | |
| MI | 0F36426 | Medicare PIN | |
| MI | 0M76760 | Medicare PIN | |
| MI | 0N25690 | Medicare PIN | |
| MI | 0F36139 | Medicare PIN | |
| MI | 0F36238 | Medicare PIN | |
| MI | 0F37700 | Medicare PIN | |
| MI | 0F31234 | Medicare PIN | |
| MI | 0F364420 | Other | BCBSM |
| MI | 0F36239 | Medicare PIN | |
| MI | 0F36076 | Medicare PIN | |
| MI | 0F36442 | Medicare PIN | |
| MI | 0N74270 | Medicare PIN | |
| MI | 0F36084 | Medicare PIN | |
| MI | 0F36116 | Medicare PIN | |
| MI | 0F36237 | Medicare PIN | |
| MI | 0F37135 | Medicare PIN | |
| MI | 0F34985 | Medicare PIN |
