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Organization
HENRY FORD MACOMB ANCILLARY SERVICES
Active
Organization
HENRY FORD MACOMB ANCILLARY SERVICES
Active
Parent organization
HENRY FORD MACOMB HOSPITAL CORPORATION
Other names
HENRY FORD MACOMB IMAGING CENTER-MT. CLEMENS
Organization subpart
Yes
Provider details
NPI number
Legal business name
HENRY FORD MACOMB HOSPITAL CORPORATION
Authorized official
TERRY GOODBALIAN (VP FINANCE & CFO HFMACOMB)
(586) 263-2705
Entity
Organization
Contact information
Practice address
133 S MAIN ST, MOUNT CLEMENS, MI 48043-2308
(586) 468-1600
(586) 465-0329
Mailing address
15855 19 MILE RD, ATTN: TERRY GOODBALIAN, CLINTON TOWNSHIP, MI 48038-3504
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
293D00000X
Physiological Laboratory
—
—
Other
Enumeration date
01/09/2015
Last updated
03/03/2015
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