Provider Demographics
NPI:1912995465
Name:ASCENSION ST. MARY'S HOSPITAL
Entity Type:Organization
Organization Name:ASCENSION ST. MARY'S HOSPITAL
Other - Org Name:ASCENSION MEDICAL GROUP FRANKENMUTH FAMILY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT COORD
Authorized Official - Prefix:
Authorized Official - First Name:LAURILEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-362-9411
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:989-652-5210
Mailing Address - Fax:989-652-5219
Practice Address - Street 1:1027 W GENESEE ST
Practice Address - Street 2:POB 265
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1302
Practice Address - Country:US
Practice Address - Phone:989-652-5224
Practice Address - Fax:989-652-3741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G31031OtherBLUE CROSS BLUE SHIELD MI
MI0G31031OtherBLUE CROSS BLUE SHIELD MI