Organization
PROVIDENCE-PROVIDENCE PARK HOSPITAL
Active
Other names
PH Nurse Practitioners/Providence Hospital and Medical Centers Inc
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER JOHNSON (DIRECTOR, CENTRAL BILLING OFFICE)
(248) 680-8206
Entity
Organization
Contact information
Practice address
16001 W 9 MILE RD, PHYSICIAN BILLING SERVICES, 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
163W00000X
Registered Nurse
Primary
—
—
163WC0200X
Critical Care Medicine Registered Nurse
—
—
163WH1000X
Hospice Registered Nurse
—
—
163WM0102X
Maternal Newborn Registered Nurse
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500F319040
MI BLUE CROSS GROUP PIN #
MI
Enumeration date
04/20/2006
Last updated
08/25/2016
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