Provider Demographics
NPI:1902817620
Name:ST JOHN MACOMB-OAKLAND HOSPITAL
Entity Type:Organization
Organization Name:ST JOHN MACOMB-OAKLAND HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DARROCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-753-0305
Mailing Address - Street 1:PO BOX 673898
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-3898
Mailing Address - Country:US
Mailing Address - Phone:800-531-5788
Mailing Address - Fax:586-296-1143
Practice Address - Street 1:11800 E 12 MILE RD
Practice Address - Street 2:ER DEPARTMENT
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3472
Practice Address - Country:US
Practice Address - Phone:586-573-5028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E06122Medicare PIN