NPIMap

Organization Active NPI

St John Hospital and Medical Center

  • Clinic/Center
  • Saint Clair Shores, MI
National Provider Identifier
1831220797
Registry record updated Jun 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ST JOHN HOSPITAL AND MEDICAL CENTER
Practice address
24911 Little Mack Ave
Suite C
Saint Clair Shores, MI 48080-3200
Phone
(586) 753-0011
NPI assigned
Mar 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2009

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

Authorized official

Name
Mr. Christopher J Palazzolo
Title
V.P.-Finance
Phone
(313) 343-3558

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

24911 Little Mack Ave
Suite C
Saint Clair Shores, MI 48080-3200

Mailing address

28000 Dequindre Rd
Warren, MI 48092-2468
Phone (586) 753-0011

Other identifiers 1

IdentifierTypeStateIssuer
0E07766OtherMIBCBSM PIN

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244592000000",
    "number": "1831220797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28000 DEQUINDRE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922468",
            "telephone_number": "586-753-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24911 LITTLE MACK AVE",
            "address_2": "SUITE C",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480803200",
            "telephone_number": "586-753-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN HOSPITAL AND MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2009-06-10",
        "status": "A",
        "authorized_official_last_name": "PALAZZOLO",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "V.P.-FINANCE",
        "authorized_official_telephone_number": "313-343-3558",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PIN",
            "identifier": "0E07766",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.