Organization
ASCENSION PROVIDENCE HOSPITAL
Active
Organization
ASCENSION PROVIDENCE HOSPITAL
Active
Other names
PH Physicians Assistants/Providence Hospital and Medical Centers Inc
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH STARKEL (SUPERVISOR, ENROLLMENT)
(248) 680-8206
Entity
Organization
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-3000
(248) 849-2244
Mailing address
2800 LIVERNOIS RD, SUITE 500, TROY, MI 48083-1215
(248) 680-8000
(248) 680-8032
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N89760
MEDICARE GROUP PIN #
MI
Enumeration date
04/20/2006
Last updated
06/28/2022
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