| Providence Hospital & Medical Centers | |
|
16001 W 9 Mile Rd Southfield MI 48075-4818 | |
| (248) 746-3200 | |
| (248) 746-0384 |
| Full Name | Providence Hospital & Medical Centers |
|---|---|
| Speciality | Psychologist |
| Location | 16001 W 9 Mile Rd, Southfield, Michigan |
| Authorized Official Name and Position | William T C Crowe (CFO CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2488495707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Hospital & Medical Centers 16001 W 9 Mile Rd Southfield MI 48075-4818 Ph: (248) 746-3200 | Providence Hospital & Medical Centers 16001 W 9 Mile Rd Southfield MI 48075-4818 Ph: (248) 746-3200 |
| NPI Number | 1962487215 |
|---|---|
| Provider Enumeration Date | 12/09/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962487215 | NPI | - | NPPES |
| 00231 | Other | BLUE CROSS | |
| 00277 | Other | BLUE CROSS | |
| 40277 | Other | BLUE CROSS | |
| 1557829 | Medicaid | MI | |
| 41277 | Other | BLUE CROSS | |
| 5171708 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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