Provider Demographics
NPI:1255316584
Name:ASCENSION PROVIDENCE HOSPITAL
Entity type:Organization
Organization Name:ASCENSION PROVIDENCE HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, VAL BASED ENT & CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMSCHRODER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-876-8452
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:248-849-3000
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:248-849-3000
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:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes273Y00000XHospital UnitsRehabilitation UnitGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2775475Medicaid
MI23T019Medicare Oscar/Certification