Provider Demographics
NPI:1144779885
Name:ASCENSION STANDISH HOSPITAL
Entity Type:Organization
Organization Name:ASCENSION STANDISH HOSPITAL
Other - Org Name:ASCENSION STANDISH HOSPITAL HEALTHCARE ASSOCIATES OF STANDISH
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-362-9411
Mailing Address - Street 1:805 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9526
Mailing Address - Country:US
Mailing Address - Phone:989-846-3503
Mailing Address - Fax:989-846-3536
Practice Address - Street 1:805 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9526
Practice Address - Country:US
Practice Address - Phone:989-846-3503
Practice Address - Fax:989-846-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty