Provider Demographics
NPI:1447543095
Name:ST. JOSEPH MERCY HOSPITAL
Entity type:Organization
Organization Name:ST. JOSEPH MERCY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KARADJOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-985-1500
Mailing Address - Street 1:6464 LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:BURTCHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48059-2557
Mailing Address - Country:US
Mailing Address - Phone:810-488-0551
Mailing Address - Fax:
Practice Address - Street 1:6464 LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:BURTCHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48059-2557
Practice Address - Country:US
Practice Address - Phone:810-488-0551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234999282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital