Provider Demographics
NPI:1174634315
Name:SEGUE INC
Entity Type:Organization
Organization Name:SEGUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-784-6729
Mailing Address - Street 1:PO BOX 6159
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-6159
Mailing Address - Country:US
Mailing Address - Phone:517-784-6729
Mailing Address - Fax:517-784-7546
Practice Address - Street 1:212 E. BIDDLE STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203
Practice Address - Country:US
Practice Address - Phone:517-784-6729
Practice Address - Fax:517-745-4841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI260C811710OtherBLUE CROSS BLUE SHLD MICH
MI4924298Medicaid
MI260C811710OtherBLUE CROSS BLUE SHLD MICH