# ST JOHN HOSPITAL AND MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144460676
- **Authorized official:** SUSAN FIELD (SR DIRECTOR)
- **Authorized official phone:** (586) 753-0011

## Contact information

- **Practice address:** 22101 MOROSS RD, DETROIT, MI 48236-2148
- **Practice address phone:** (586) 753-0011
- **Mailing address:** 28800 DEQUINDRE RD, WARREN, MI 48092-2466
- **Mailing address phone:** (586) 753-0011

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 367H00000X | Anesthesiologist Assistant | — | — | Yes |

## Other

- **Enumeration date:** 02/24/2009
- **Last updated:** 02/24/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0866958 | BLUE CROSS | — |