Provider Demographics
NPI:1780841262
Name:ASCENSION ST. MARY'S HOSPITAL
Entity Type:Organization
Organization Name:ASCENSION ST. MARY'S HOSPITAL
Other - Org Name:ST MARY'S MEDICAL CENTER OF SAGINAW INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRES. ADMINSTR AMG MID MI
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUELDENZOPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-907-7509
Mailing Address - Street 1:28000 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2468
Mailing Address - Country:US
Mailing Address - Phone:586-753-0275
Mailing Address - Fax:
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:989-497-7524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P24310Medicare PIN
P00457008Medicare PIN