Provider Demographics
NPI:1790811123
Name:HEALTHSOURCE SAGINAW, INC.
Entity Type:Organization
Organization Name:HEALTHSOURCE SAGINAW, INC.
Other - Org Name:HEALTHSOURCE SAGINAW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-790-7790
Mailing Address - Street 1:3340 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-9622
Mailing Address - Country:US
Mailing Address - Phone:989-790-7729
Mailing Address - Fax:989-790-7723
Practice Address - Street 1:3340 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-9622
Practice Address - Country:US
Practice Address - Phone:989-790-7729
Practice Address - Fax:989-790-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010017913336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2324541Medicaid
2041773OtherPK
MI2805206Medicaid