Provider Demographics
NPI:1649397225
Name:MID MICHIGAN VASCULAR SURGERY, P.C.
Entity Type:Organization
Organization Name:MID MICHIGAN VASCULAR SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-790-2600
Mailing Address - Street 1:4701 TOWNE CENTRE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2834
Mailing Address - Country:US
Mailing Address - Phone:989-790-2600
Mailing Address - Fax:989-790-3311
Practice Address - Street 1:4701 TOWNE CENTRE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2834
Practice Address - Country:US
Practice Address - Phone:989-790-2600
Practice Address - Fax:989-790-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010535482086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0738353OtherBCBSM
MI3158841Medicaid
MI0N84760Medicare ID - Type Unspecified
MI3158841Medicaid