Provider Demographics
NPI:1609412527
Name:ASCENSION ST. MARY'S HOSPITAL
Entity Type:Organization
Organization Name:ASCENSION ST. MARY'S HOSPITAL
Other - Org Name:ASCENSION MEDICAL GROUP INTENSIVISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMG MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-907-7501
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:989-907-7636
Mailing Address - Fax:989-907-7584
Practice Address - Street 1:800 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2551
Practice Address - Country:US
Practice Address - Phone:989-907-8000
Practice Address - Fax:989-907-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty