Provider Demographics
NPI:1346486081
Name:ST MARYS OF MICHIGAN SPECIALISTS
Entity Type:Organization
Organization Name:ST MARYS OF MICHIGAN SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:989-497-3095
Mailing Address - Street 1:4690 MCLEOD DR E
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2836
Mailing Address - Country:US
Mailing Address - Phone:989-249-5454
Mailing Address - Fax:989-249-5468
Practice Address - Street 1:4690 MCLEOD DR E
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2836
Practice Address - Country:US
Practice Address - Phone:989-249-5454
Practice Address - Fax:989-249-5468
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARYS OF MICHIGAN SPECIALIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty