Provider Demographics
NPI:1326658154
Name:ASCENSION ST. MARY'S HOSPITAL
Entity Type:Organization
Organization Name:ASCENSION ST. MARY'S HOSPITAL
Other - Org Name:ASCENSION MEDICAL GROUP PRIMARY CARE TOWNE CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT COORD
Authorized Official - Prefix:
Authorized Official - First Name:LAURILEE
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:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-780-2455
Mailing Address - Fax:989-401-8485
Practice Address - Street 1:4705 TOWNE CENTRE RD STE 204
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2819
Practice Address - Country:US
Practice Address - Phone:989-780-2455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty