# ST JOHN MACOMB OAKLAND HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St John Macomb Oakland Hospital - St John Detroit Riverview Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770750309
- **Authorized official:** RANDOLPH KUMMLER (VP FINANCE)
- **Authorized official phone:** (586) 573-5910

## Contact information

- **Practice address:** 7733 E JEFFERSON AVE, DETROIT, MI 48214-3707
- **Practice address phone:** (313) 499-4000
- **Mailing address:** 28000 DEQUINDRE RD, WARREN, MI 48092-2468
- **Mailing address phone:** (586) 753-0275

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | 282N00000X | MI | Yes |

## Other

- **Enumeration date:** 05/13/2008
- **Last updated:** 06/17/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00048 | BLUE CROSS PIN | — |