Organization
HENRY FORD MACOMB HOSPITAL CORPORATION
Active
Parent organization
HENRY FORD MACOMB HOSPITAL CORPORATION
Other names
Henry Ford Macomb Hospital-CRNA
Organization subpart
Yes
Provider details
NPI number
Legal business name
HENRY FORD MACOMB HOSPITAL CORPORATION
Authorized official
TERRY GOODBALIAN (CHIEF FINANCIAL OFFICER)
(586) 263-2704
Entity
Organization
Contact information
Practice address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(586) 263-2370
Mailing address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(586) 263-2370
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
217476800
USDOL
MI
01
—
430E062120
BCBS
MI
01
—
4566853
AETNA
MI
01
—
508593
CARE CHOICES
MI
01
—
HL500038
MCARE
MI
Enumeration date
11/14/2006
Last updated
12/11/2014
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