Provider Demographics
NPI:1942333786
Name:TRINITY HEALTH MICHIGAN
Entity Type:Organization
Organization Name:TRINITY HEALTH MICHIGAN
Other - Org Name:MERCY PRIMARY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAWANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NETTLES-ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-692-8400
Mailing Address - Street 1:5555 CONNER ST
Mailing Address - Street 2:STE. 2691
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-3448
Mailing Address - Country:US
Mailing Address - Phone:313-692-8400
Mailing Address - Fax:313-692-8431
Practice Address - Street 1:5555 CONNER ST
Practice Address - Street 2:STE. 2691
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3448
Practice Address - Country:US
Practice Address - Phone:313-692-8400
Practice Address - Fax:313-692-8431
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRRINTY HEALTH MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF66035Medicare UPIN