Basic Information
| Provider Information | |||||||||
| NPI: | 1538573605 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCENSION ST. MARY'S HOSPITAL | ||||||||
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| OtherOrganizationName: | ASCENSION MEDICAL GROUP HEMATOLOGY AND ONCOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 779 | ||||||||
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| City: | TAWAS CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487640779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894973226 | ||||||||
| FaxNumber: | 9894673146 | ||||||||
| Practice Location | |||||||||
| Address1: | 4599 TOWNE CENTRE RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9899078789 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2014 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCORD | ||||||||
| AuthorizedOfficialFirstName: | LAURILEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ENROLLMENT COORD | ||||||||
| AuthorizedOfficialTelephone: | 9893629411 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.