Organization
ST MARY MERCY HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL PAUL GUSHO (CHEIF FINANCIAL OFFICER)
(734) 655-2909
Entity
Organization
Contact information
Practice address
36475 5 MILE RD, LIVONIA, MI 48154-1971
(735) 655-4800
(734) 655-2609
Mailing address
36475 FIVE MILE ROAD, LIVONIA, MI 48154-9978
(735) 655-4800
(734) 655-2609
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00243
BCBSM ACUTE CARE
MI
05
—
4200538
—
MI
05
—
4200547
—
MI
Enumeration date
12/14/2006
Last updated
07/17/2007
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