1811097876 NPI number — ASCENSION ST. MARY'S HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811097876 NPI number — ASCENSION ST. MARY'S HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCENSION ST. MARY'S HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ASCENSION MEDICAL GROUP SAGINAW VALLEY PEDIATRICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811097876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 779
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAWAS CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48764-0779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-797-1041
Provider Business Mailing Address Fax Number:
989-799-0256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5821 COLONY DR N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48638-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-797-1040
Provider Business Practice Location Address Fax Number:
989-799-0256
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCORD
Authorized Official First Name:
LAURILEE
Authorized Official Middle Name:
Authorized Official Title or Position:
ENROLLMENT COORD
Authorized Official Telephone Number:
989-362-9411

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 350G31019 . This is a "BCBS COMMON PROVIDER CODE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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