Organization
ST MARY MERCY PHYSICIAN PRACTICES
Active
Parent organization
ST MARY MERCY PHYSICIAN PRACTICES
Other names
St Mary Mercy Oncology Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST MARY MERCY PHYSICIAN PRACTICES
Authorized official
DAVID SPIVEY (PRESIDENT / CEO)
(734) 655-1610
Entity
Organization
Contact information
Practice address
14555 LEVAN RD, SUITE 112, LIVONIA, MI 48154-5083
(734) 779-2123
(734) 779-2163
Mailing address
20555 VICTOR PKWY, SE MI SHARED SERVICES W3D, LIVONIA, MI 48152-7031
(734) 343-0282
(248) 380-4445
Taxonomy
Speciality
Code
Description
License number
State
261QX0200X
Oncology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H27566
BLUE SHIELD PIN
MI
Enumeration date
12/05/2011
Last updated
11/03/2015
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