Basic Information
| Provider Information | |||||||||
| NPI: | 1780615708 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAGINAW VALLEY BONE & JOINT CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5483 GRATIOT RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486386037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897995557 | ||||||||
| FaxNumber: | 9897992840 | ||||||||
| Practice Location | |||||||||
| Address1: | 5483 GRATIOT RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486386037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897995557 | ||||||||
| FaxNumber: | 9897992840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WATZ | ||||||||
| AuthorizedOfficialFirstName: | SUZANNE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9897995557 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MI | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.