1609412527 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 1609412527 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 INTENSIVISTS
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:
1609412527
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:
989-907-7636
Provider Business Mailing Address Fax Number:
989-907-7584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 S WASHINGTON AVE
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:
48601-2551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-907-8000
Provider Business Practice Location Address Fax Number:
989-907-8343
Provider Enumeration Date:
11/26/2019

Additional Information

Authorized Official

Authorized Official Last Name:
GORDIE
Authorized Official First Name:
TRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
AMG MANAGER
Authorized Official Telephone Number:
989-907-7501

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com