Provider Demographics
NPI:1093070591
Name:ST. MARY'S OF MICHIGAN
Entity Type:Organization
Organization Name:ST. MARY'S OF MICHIGAN
Other - Org Name:ST. MARY'S EMERGENCY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIETZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-907-8789
Mailing Address - Street 1:800 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4677 TOWNE CENTRE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2846
Practice Address - Country:US
Practice Address - Phone:989-793-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty