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Contact Information

ST JOHN PROVIDENCE HEALTH SYSTEM
16001 W 9 MILE RD
SOUTHFIELD, MI48075-4818
 Phone: 248-849-3000
 Fax: 248-849-2244
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Adult Health

363LA2200X 50 Nurse Practitioner
 

Diabetes Educator

163WD0400X
 

Nursing Care

251J00000X
Indicates primary specialty

NPI Profile & details for ST JOHN PROVIDENCE HEALTH SYSTEM

NPI Number 1922063213
LBN Legal business name ST JOHN PROVIDENCE HEALTH SYSTEM
Authorized official KIMBERLY CEBALT - (DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 04/19/2006
Last updated 02/16/2026 - About 4 months ago
Identifiers
MI Other 110F364771 MI BLUE CROSS GOUP PIN #
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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