Provider Demographics
NPI:1700815347
Name:ST JOSEPH MERCY CHELSEA INC
Entity Type:Organization
Organization Name:ST JOSEPH MERCY CHELSEA INC
Other - Org Name:ST. JOSEPH MERCY CHELSEA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR REVENUE MANAGEMENT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-343-0282
Mailing Address - Street 1:34505 W 12 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3286
Mailing Address - Country:US
Mailing Address - Phone:734-343-3922
Mailing Address - Fax:312-957-2766
Practice Address - Street 1:775 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1383
Practice Address - Country:US
Practice Address - Phone:734-593-6000
Practice Address - Fax:734-593-5365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMCAREOtherHL81007
MIHEALTH ALLIANCE PLANOther230259
MICARE CHOICESOther100084
MIBLUE CROSSOther00252
MIBLUE CROSSOther00252
MICARE CHOICESOther100084