Provider Demographics
NPI:1265523328
Name:BLOOMFIELD MEDICAL CENTER PLC
Entity type:Organization
Organization Name:BLOOMFIELD MEDICAL CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-203-1282
Mailing Address - Street 1:PO BOX 32588
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-0588
Mailing Address - Country:US
Mailing Address - Phone:248-203-1282
Mailing Address - Fax:248-203-4148
Practice Address - Street 1:23900 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2501
Practice Address - Country:US
Practice Address - Phone:248-203-1282
Practice Address - Fax:248-203-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104426188Medicaid
MI104796788Medicaid
MIB48651Medicare UPIN