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Organization
WILLIAM BEAUMONT HOSPITAL
Active
Organization
WILLIAM BEAUMONT HOSPITAL
Active
Parent organization
BEAUMONT FASTCARE RETAIL MEDICINE
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEAUMONT FASTCARE RETAIL MEDICINE
Authorized official
LEE ANN ODOM (PRESIDENT SHARED SERVICES)
(947) 522-3326
Entity
Organization
Contact information
Practice address
5150 COOLIDGE HWY, BEAUMONT FASTCARE RETAIL MEDICINE, ROYAL OAK, MI 48073-1001
(248) 655-3227
Mailing address
26901 BEAUMONT BLVD, COMPLIANCE, SOUTHFIELD, MI 48033-4716
(947) 522-1964
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F359270
BCBSM
MI
01
—
0F37078
BCBSM
MI
Enumeration date
10/05/2016
Last updated
10/07/2021
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