Provider Demographics
NPI:1013319201
Name:BARBARA ANN KARMANOS CANCER HOSPITAL
Entity Type:Organization
Organization Name:BARBARA ANN KARMANOS CANCER HOSPITAL
Other - Org Name:KARMANOS CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-576-8935
Mailing Address - Street 1:4100 JOHN R ST
Mailing Address - Street 2:SUITE HP00RX
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2013
Mailing Address - Country:US
Mailing Address - Phone:313-576-9350
Mailing Address - Fax:313-576-9353
Practice Address - Street 1:4100 JOHN R ST
Practice Address - Street 2:SUITE HP00RX
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2013
Practice Address - Country:US
Practice Address - Phone:313-576-9350
Practice Address - Fax:313-576-9353
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARBARA ANN KARMANOS CANCER HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-19
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MI53010104643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7299430001Medicare NSC