NPIMap

Organization Active NPI

Providence Hospital

  • General Acute Care Hospital
  • Southfield, MI
National Provider Identifier
1093943615
Registry record updated Jun 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
4301094326 Issued in MI
Legal business name
PROVIDENCE HOSPITAL
Practice address
22250 Providence Dr
Suite 500
Southfield, MI 48075-4825
Phone
(248) 849-3447
Fax
(248) 849-5389
NPI assigned
Jun 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2009

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

Authorized official

Name
Dr. Kai Kinyell Palm, M.D.
Title
Resident Physician
Phone
(313) 622-5004

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 4301094326 MI
Primary Care Clinic/Center 261QP2300X 4301094326 MI
General Acute Care Hospital 282N00000X 4301094326 MI Primary

Addresses

Primary practice location

22250 Providence Dr
Suite 500
Southfield, MI 48075-4825

Mailing address

11692 Beaverland
Detroit, MI 48239-1357
Phone (313) 622-5004

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0902426Ascension Providence Hospital Southfield22250 Providence Drive Suite 301, Southfield, MI 48075Certificate of waiverMar 28, 2028

National Provider Directory

National Provider Directory
Tax ID family
Providence Hosp Med Cen Inc32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245715200000",
    "number": "1093943615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11692 BEAVERLAND",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482391357",
            "telephone_number": "313-622-5004",
            "fax_number": "248-849-5389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22250 PROVIDENCE DR",
            "address_2": "SUITE 500",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754825",
            "telephone_number": "248-849-3447",
            "fax_number": "248-849-5389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-23",
        "last_updated": "2009-06-23",
        "status": "A",
        "authorized_official_last_name": "PALM",
        "authorized_official_first_name": "KAI",
        "authorized_official_middle_name": "KINYELL",
        "authorized_official_title_or_position": "RESIDENT PHYSICIAN",
        "authorized_official_telephone_number": "313-622-5004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MI",
            "license": "4301094326",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MI",
            "license": "4301094326",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MI",
            "license": "4301094326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.