PROVIDENCE HOSPITAL (NPI# 1093943615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093943615 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HOSPITAL |
| Practice Address |
22250 Providence Dr Suite 500 Southfield MI 48075-4825 |
| Mailing Address |
11692 Beaverland Detroit MI 48239-1357 |
| Practice Telephone | 2488493447 |
| Practice Fax Number | 2488495389 |
| Mailing Telephone | 3136225004 |
| Mailing Fax Number | 2488495389 |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2009-06-23 |
| Authorized Official Name | DR. KAI KINYELL PALM (RESIDENT PHYSICIAN) |
| Authorized Official Telephone | 3136225004 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | 4301094326 | MI | Ambulatory Health Care Facilities |
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
4301094326 | MI | Ambulatory Health Care Facilities |
| Y | 282N00000X | General Acute Care Hospital | 4301094326 | MI | Hospitals |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134584667 | Providence Hospital | Clinic/Center | 3413 Olive Branch Dr, Silver Spring, MD 20904-4973 | 2015-12-29 |
| 1881891372 | Providence Hospital | Chronic Disease Hospital | 16400 N Park Dr Apt 1008, Southfield, MI 48075-4728 | 2007-06-28 |
| 1548486681 | Providence Hospital | General Acute Care Hospital | 10508 Keane Dr, Grass Lake, MI 49240-8803 | 2007-04-17 |
| 1932277050 | Providence Hospital | Rehabilitation Hospital | 6351 Woodside Dr, Theodore, AL 36582-6061 | 2006-11-30 |
| 1861057416 | Providence Hospital | Clinic/Center | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-05-08 |
| 1861954638 | Providence Hospital | Emergency Medicine | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-04-02 |
| 1710362496 | Providence Hospital | General Acute Care Hospital | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2015-07-23 |
| 1871922971 | Providence Hospital | Hospitalist | 6801 Airport Blvd, Hospitalist Dept., Mobile, AL 36608-3709 | 2013-11-08 |
| 1992133912 | Providence Hospital | Anesthesiology | 6801 Airport Blvd, Anesthesia Dept., Mobile, AL 36608-3709 | 2013-10-30 |
| 1659707149 | Providence Hospital | General Acute Care Hospital | 1150 Varnum St Ne, Washington, DC 20017-2104 | 2013-09-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PROVIDENCE HOSPITAL | 914 S Scheuber Rd, Centralia, WA 98531-9027 |
| System for Award Management (SAM) Entities | PROVIDENCE HOSPITAL AND MEDICAL CENTERS | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 |
| Iowa Business Entities | PROVIDENCE HOSPITALITY PARTNERS LLC | 709 Clarkson St, Denver, CO 80218 |
| Colorado Business Entities | PROVIDENCE HOSPITALITY PARTNERS LLC | 1888 N Sherman St, Suite 610, Denver, CO 80203 |
| New York State Corporations | PROVIDENCE HOSPITALITY PARTNERS LLC | 1888 N Sherman St, Suite 610, Denver, Co 80203 |
| Street Address |
22250 PROVIDENCE DR SUITE 500 |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48075-4825 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710981071 | Anthony Edward Boutt | Obstetrics & Gynecology | 22250 Providence Dr, 408, Southfield, MI 48075-4825 | 2005-06-02 |
| 1871110015 | Abbas Chehab | Internal Medicine | 22250 Providence Dr, Southfield, MI 48075-4825 | 2020-07-04 |
| 1013531854 | Anicia Mirchandani | Radiology | 22250 Providence Dr, Southfield, MI 48075-4825 | 2020-06-06 |
| 1285258442 | Kidist Tamirat Arficho | Student in an Organized Health Care Education/Training Program | 22250 Providence Dr, Southfield, MI 48075-4825 | 2020-06-03 |
| 1386268035 | Denas Andrijauskis | Surgery | 22250 Providence Dr, Southfield, MI 48075-4825 | 2020-05-28 |
| 1669030748 | Cyrus Garmo | Student in an Organized Health Care Education/Training Program | 22250 Providence Dr, Southfield, MI 48075-4825 | 2019-06-03 |
| 1922661297 | Ammar Hassen Alsalahi | Student in an Organized Health Care Education/Training Program | 22250 Providence Dr, Suite #601, Southfield, MI 48075-4814 | 2019-04-22 |
| 1265963797 | Cameron Whitler | Internal Medicine | 22250 Providence Dr, Suite 705, Southfield, MI 48075-4818 | 2017-03-26 |
| 1144671082 | Jessica Anne Hudson | Family Medicine | 22250 Providence Dr, Ste. 500, Southfield, MI 48075-4825 | 2016-06-22 |
| 1689024960 | Yessar Takruri | Internal Medicine | 22250 Providence Dr, Southfield, MI 48075-4825 | 2016-06-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851900054 | K&b Medical Wigs, LLC | Durable Medical Equipment & Medical Supplies | 16250 Northland Dr. Ste 221, Southfield, MI 48075 | 2020-07-24 |
| 1790300390 | Julian Jeberaeel | Radiology | 2250 Providence, Southfield, MI 48075 | 2020-06-10 |
| 1265056410 | Husein Yusuf Husein | Podiatrist | Ascension Providence Hospital Southfield Campus, 16001 W. Nine Mile Rd. Depaul 2nd Floor, Southfield, Mi, MI 48075 | 2020-06-03 |
| 1952945420 | Paris Straughter | Nurse Practitioner | 18438 Onyx St, Southfield, MI 48075 | 2019-10-29 |
| 1811467657 | Medicine Man Medical, Pllc | Physical Medicine & Rehabilitation | 25130 Southfield Road, Suite #210, Southfield, MI 48075 | 2018-12-04 |
| 1447725528 | Rommel Ramos Perez | Physical Therapist | 26017 Greenfield Rd., Southfield, MI 48075 | 2018-10-04 |
| 1073009627 | Jacqueline Venora Goodgame | Licensed Practical Nurse | 4000 Town Ctr, Southfield, MI 48075 | 2018-07-06 |
| 1043712532 | Hollie Marie Maltese | Physical Therapy Assistant | 22255 Greenfiled 118, Southfield, MI 48075 | 2018-03-01 |
| 1932601481 | Katie Marie Mccormack | Occupational Therapist | 16001 West Nine Mile Rd., Southfield, MI 48075 | 2018-03-01 |
| 1801304241 | Absolute Hc LLC | Physical Therapist | 23461 Greenfield Rd Ste 200b, Southfield, MI 48075 | 2018-01-19 |
| Find all providers in zip 48075 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003139148 | Michigan Center for Physical Therapy Inc | General Acute Care Hospital | 30770 Southfield Rd, Southfield, MI 48076-7739 | 2010-03-03 |
| 1811364185 | Saira Ahmad | General Acute Care Hospital | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2015-08-21 |
| 1710362496 | Providence Hospital | General Acute Care Hospital | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2015-07-23 |
| 1649652686 | St. John Providence Hospital | General Acute Care Hospital | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2015-06-26 |
| 1679981104 | Ngozi Uche Onyesoh | General Acute Care Hospital | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2014-07-28 |
| 1700155579 | St John Providence Health System | General Acute Care Hospital | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2011-12-22 |
| 1376853937 | St John Providence Health | General Acute Care Hospital | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2010-10-18 |
| 1134367055 | Southfield Rehabilitation Company | General Acute Care Hospital | 22401 Foster Winter Drive, Southfield, MI 48075-3724 | 2009-01-30 |
| 1972763308 | Providence Hospital | General Acute Care Hospital | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2008-06-10 |
| 1669648937 | Providence Hospital | General Acute Care Hospital | 16001 W 9 Mile Rd, Infusion Dept, Southfield, MI 48075-4818 | 2008-05-06 |
| Find all providers in SOUTHFIELD | ||||
| City | SOUTHFIELD |
| Zip Code | 48075 |
Please comment or provide details below to improve the information on PROVIDENCE HOSPITAL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.