Provider Demographics
NPI:1336174440
Name:OAKWOOD HEALTHCARE, INC.
Entity Type:Organization
Organization Name:OAKWOOD HEALTHCARE, INC.
Other - Org Name:BEAUMONT HOSPITAL - DEARBORN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT SHARED SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:947-522-3338
Mailing Address - Street 1:26901 BEAUMONT BLVD.
Mailing Address - Street 2:COMPLIANCE
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-4716
Mailing Address - Country:US
Mailing Address - Phone:947-522-1963
Mailing Address - Fax:
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-593-7000
Practice Address - Fax:313-436-2038
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKWOOD HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8201202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOK20001OtherM-CARE PROFESSIONAL PROV#
MI000000002105OtherCAPE HEALTH PROF PROV #
MI101577115Medicaid
MI060024539OtherRAILROAD PROF PROV #
MI0H26396OtherBC PROFESSIONAL PROV #
MI000000002105OtherCAPE HEALTH PROF PROV #