1649597998 NPI number — ASCENSION ST. MARY'S HOSPITAL

Table of content: (NPI 1649597998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649597998 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:
ST. MARYS PLASTIC, RECONSTRUCTIVE, COSMETIC AND HAND SURGERY
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:
1649597998
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:
989-497-3157
Provider Business Mailing Address Fax Number:
989-497-3158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4705 TOWNE CTR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48604-2818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-497-3157
Provider Business Practice Location Address Fax Number:
989-497-3158
Provider Enumeration Date:
04/27/2010

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  5101015176 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2082S0105X , with the licence number: 5101015176 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 5101015176 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1639263098 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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