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Organization Active NPI

Henry Ford Wyandotte Hospital

  • Ambulatory Surgical Clinic/Center
  • Wyandotte, MI
National Provider Identifier
1093901035
Registry record updated Jul 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
826849 Issued in MI
Legal business name
HENRY FORD WYANDOTTE HOSPITAL
Practice address
2333 Biddle St
Wyandotte, MI 48192-4668
Phone
(734) 246-6000
Fax
(734) 246-6986
NPI assigned
Sep 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Terry Goodbalian
Title
Cfo
Phone
(734) 246-6044

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 826849 MI Primary

Addresses

Primary practice location

2333 Biddle St
Wyandotte, MI 48192-4668

Mailing address

23050 West Rd
Brownstown TWP, MI 48183-1472
Phone (734) 287-9880

Other identifiers 1

IdentifierTypeStateIssuer
40013OtherMIBLUE CROSS

Other names 1

  • HENRY FORD HEALTH CENTER BROWNSTOWN Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071210000516 MI Part A Provider - Hospital 2264334499 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brownstown TWP, MI; Wyandotte, MI

Hospital certification: CCN 230146

Legal name
HENRY FORD WYANDOTTE HOSPITAL
Doing business as
WYANDOTTE HOSPITAL AND MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Sep 12, 2012
Beds
345
Ownership / control type
Private (not for profit)
Most recent change of ownership
May 1, 1988 (2 total)
Organization structure
CorporationNon-profit
Enrollment address
2333 Biddle Ave
Wyandotte, MI 48192-4668
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Wyandotte Hospital and Medical CenterCCN 230146
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

15105 Northline Rd
Southgate, MI 48195
Phone (734) 282-7734

2070 Biddle Ave
Ste 200
Wyandotte, MI 48192
Phone (734) 225-9100

2070 Biddle Ave
Ste 3
Wyandotte, MI 48192
Phone (734) 225-9187

Ownership & related parties

All disclosed owners & managing parties 31

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Daniel J. Phelan Individual Corporate Director Jan 1, 2022
Henry Ford Health System Organization, Troy, MI Corporation, Non-profit, Chain home office, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 18, 1987 100%
Charles McClure Individual Corporate Director Jan 1, 2020
Robert R Lubera Individual Corporate DirectorBoard Member Sep 1, 2025
Barry G. Porter Individual Corporate Director Jan 1, 2020
Steven Brian Bender Individual Corporate OfficerSecretary Oct 21, 2024
Gerardo Norcia Individual Corporate Director Dec 1, 2023
Robert Riney Individual Corporate Director Jul 1, 2022
Michael Rafferty Individual Corporate Director Jan 1, 2020
Jeffrey Fall Individual Corporate DirectorBoard Member Sep 1, 2025
Farzan Siddiqui Individual Corporate Director Jan 1, 2024
Marjorie Staten Individual Corporate Officer Jan 1, 2019
Rhonda M Medows Individual Corporate DirectorBoard Member Sep 1, 2025
David Breen Individual Corporate Director Jan 1, 2015
Mary Ann Victor Individual Corporate DirectorBoard Member Sep 1, 2025
Jason Williams Individual Corporate OfficerVP Reimbursement Oct 1, 2024
Anthony Rocco Tersigni Individual Corporate Director Oct 1, 2024
Robin S. Damschroder Individual Corporate Officer Jan 1, 2018
Calvin R Ford Individual Corporate DirectorBoard Member Jan 1, 2025
Robert Young Individual W-2 Managing Employee Jan 1, 2020
Gregory Pflum Individual Corporate DirectorBoard Member Sep 1, 2025
Henry Ford Health Parent Organization, Detroit, MI Created for acquisition, Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2024 80%
Edward D Callaghan Individual Corporate DirectorBoard Member Sep 1, 2025
John F. Harris Individual Corporate Director Jan 1, 2021
Ascension Health Organization, Saint Louis, MO Non-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2024 20%
Edgar Vann Individual Corporate Director Jan 1, 2015
Lisa Fitzpatrick Individual Corporate DirectorBoard Member Sep 1, 2025
Joseph Richardson Individual Corporate Director Jan 1, 2016
Gwendolyn M Mackenzie Individual Corporate DirectorBoard Member Sep 1, 2025
Jacalyn S. Goforth Individual Corporate Director Jan 1, 2022
Eugene F Lovasco Individual Corporate Director Oct 1, 2024

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 842

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 842

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437609600000",
    "number": "1093901035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23050 WEST RD",
            "city": "BROWNSTOWN TWP",
            "state": "MI",
            "postal_code": "481831472",
            "telephone_number": "734-287-9880",
            "fax_number": "734-246-6986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 BIDDLE ST",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481924668",
            "telephone_number": "734-246-6000",
            "fax_number": "734-246-6986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY FORD WYANDOTTE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2015-07-23",
        "status": "A",
        "authorized_official_last_name": "GOODBALIAN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "734-246-6044",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MI",
            "license": "826849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "40013",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HENRY FORD HEALTH CENTER BROWNSTOWN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wyandotte, MI

Sources for this page

Verify at the official NPI Registry.