Provider Demographics
NPI:1396789434
Name:ASCENSION MACOMB OAKLAND HOSPITAL
Entity type:Organization
Organization Name:ASCENSION MACOMB OAKLAND HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TOMASINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-343-7676
Mailing Address - Street 1:11800 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3472
Mailing Address - Country:US
Mailing Address - Phone:586-573-5260
Mailing Address - Fax:586-573-5364
Practice Address - Street 1:11800 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3472
Practice Address - Country:US
Practice Address - Phone:586-573-5260
Practice Address - Fax:586-573-5364
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOHN MACOMB-OAKLAND HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI430E064630OtherBCBS
MIAN500006OtherMCARE
MI7853578OtherAETNA
MI135863102OtherUSDOL
MI135863102OtherUSDOL
MI7853578OtherAETNA