Provider Demographics
NPI:1053550996
Name:ST. JOHN HOSPITAL AND MEDICAL CENTER
Entity type:Organization
Organization Name:ST. JOHN HOSPITAL AND MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:/CHIEF/PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SARAVOLATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-343-7311
Mailing Address - Street 1:22201 MOROSS RD
Mailing Address - Street 2:PROFESSIONAL BUILDING TWO, SUITE 50
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2169
Mailing Address - Country:US
Mailing Address - Phone:313-343-7774
Mailing Address - Fax:
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:PROFESSIONAL BUILDING TWO, SUITE 50
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2169
Practice Address - Country:US
Practice Address - Phone:313-343-7774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089471261Q00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center