Provider Demographics
NPI:1336737030
Name:WILLIAM BEAUMONT HOSPITAL
Entity Type:Organization
Organization Name:WILLIAM BEAUMONT HOSPITAL
Other - Org Name:BEAUMONT SERVICE CENTER
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:947-522-3326
Mailing Address - Street 1:26901 BEAUMONT BLVD., BLDG. F
Mailing Address - Street 2:BEAUMONT SERVICE CENTER
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 1:26901 BEAUMONT BLVD., BLDG. F
Practice Address - Street 2:BEAUMONT SERVICE CENTER
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4716
Practice Address - Country:US
Practice Address - Phone:947-522-1963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy