Provider Demographics
NPI:1861554040
Name:ST MARY MERCY HOSPITAL
Entity type:Organization
Organization Name:ST MARY MERCY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GUSHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-655-2909
Mailing Address - Street 1:36475 FIVE MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-9978
Mailing Address - Country:US
Mailing Address - Phone:735-655-4800
Mailing Address - Fax:734-655-2609
Practice Address - Street 1:36475 5 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1971
Practice Address - Country:US
Practice Address - Phone:735-655-4800
Practice Address - Fax:734-655-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00243OtherBCBSM ACUTE CARE
MI4200547Medicaid
MI4200538Medicaid
MI0N12200Medicare PIN
MI230002Medicare PIN