Organization
PROVIDENCE HOSPITAL & MEDICAL CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM T C CROWE (CFO CHIEF FINANCIAL OFFICER)
(248) 849-5707
Entity
Organization
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 746-3200
(248) 746-0384
Mailing address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 746-3200
(248) 746-0384
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00231
BLUE CROSS
—
01
—
00277
BLUE CROSS
—
05
—
1557829
—
MI
01
—
40277
BLUE CROSS
—
01
—
41277
BLUE CROSS
—
05
—
5171708
—
MI
Enumeration date
12/09/2005
Last updated
08/22/2020
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