Provider Demographics
NPI:1982853560
Name:HENRY FORD WYANDOTTE HOSPITAL
Entity Type:Organization
Organization Name:HENRY FORD WYANDOTTE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, FIN AND BUS DEV OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAMSCHRODER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-876-8452
Mailing Address - Street 1:2333 BIDDLE AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-4668
Mailing Address - Country:US
Mailing Address - Phone:734-246-6000
Mailing Address - Fax:734-246-6986
Practice Address - Street 1:2333 BIDDLE AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4668
Practice Address - Country:US
Practice Address - Phone:734-246-6000
Practice Address - Fax:734-246-6986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI820230283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI301892495Medicaid
MI00285OtherBCN
MI00285OtherBLUE CROSS
MI00285OtherBLUE CROSS
MI301892495Medicaid
MI23T146Medicare Oscar/Certification
MI0N56710Medicare PIN
MI0Q24656Medicare PIN
MI0Q24657Medicare PIN