Basic Information
| Provider Information | |||||||||
| NPI: | 1154087914 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCENSION ST. MARY'S HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 779 | ||||||||
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| City: | TAWAS CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487640779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9899074382 | ||||||||
| FaxNumber: | 9897543015 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 S WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486012556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9899074382 | ||||||||
| FaxNumber: | 9897543015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2021 | ||||||||
| LastUpdateDate: | 11/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCCORD | ||||||||
| AuthorizedOfficialFirstName: | LAURILEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 9893629411 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.