Provider Demographics
NPI:1962487215
Name:PROVIDENCE HOSPITAL & MEDICAL CENTERS
Entity Type:Organization
Organization Name:PROVIDENCE HOSPITAL & MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T C
Authorized Official - Last Name:CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-849-5707
Mailing Address - Street 1:16001 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4818
Mailing Address - Country:US
Mailing Address - Phone:248-746-3200
Mailing Address - Fax:248-746-0384
Practice Address - Street 1:16001 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-746-3200
Practice Address - Fax:248-746-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00231OtherBLUE CROSS
00277OtherBLUE CROSS
40277OtherBLUE CROSS
MI1557829Medicaid
41277OtherBLUE CROSS
MI5171708Medicaid
00231OtherBLUE CROSS