Provider Demographics
NPI:1053356352
Name:ST JOSEPH MERCY HOSPITAL-SMHC
Entity type:Organization
Organization Name:ST JOSEPH MERCY HOSPITAL-SMHC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUSHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-672-3886
Mailing Address - Street 1:44405 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-858-6174
Practice Address - Fax:248-858-3795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-19
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI630140282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIHL630003OtherM-CARE IP/OP ACUTE
MI1557506OtherGREAT LAKES IP/OP ACUTE
MI00008OtherBLUE CROSS IP/OP ACUTE
MI5172026Medicaid
MI88414AOtherHAP IP/OP ACUTE
MIM029978OtherCHAMPUS IP/OP ACUTE
MI100018OtherCARE CHOICES IP/OP ACUTE
MI123120-0001OtherWELLNESS IP ACUTE
MI123120-0002OtherWELLNESS OP ACUTE
MI911000OtherSELECTCARE IP/OP ACUTE
MI1557506Medicaid
MI16315OtherOMNICARE IP/OP ACUTE
MI501048OtherULTIMED IP/OP ACUTE
MI1557506Medicaid