Organization
ST JOHN MEDICAL CENTER MACOMB TOWNSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TOMASINE MARX (CFO)
(313) 343-7676
Entity
Organization
Contact information
Practice address
17700 23 MILE RD, MACOMB, MI 48044-1154
(586) 753-0011
Mailing address
28000 DEQUINDRE RD, WARREN, MI 48092-2468
(586) 753-0011
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E01417
BLUE CARE NETWORK PIN
MI
Enumeration date
03/09/2007
Last updated
12/03/2010
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