Healthcare Provider Details

I. General information

NPI: 1982957288
Provider Name (Legal Business Name): SAGINAW COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S 4TH AVE
SAGINAW MI
48607-1602
US

IV. Provider business mailing address

1320 N MICHIGAN AVE SUITE 2
SAGINAW MI
48602-4751
US

V. Phone/Fax

Practice location:
  • Phone: 989-755-0193
  • Fax: 989-752-0709
Mailing address:
  • Phone: 989-752-0706
  • Fax: 989-752-0709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5101013295
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601002064
License Number StateMI

VIII. Authorized Official

Name: CHIDOZIE J ONONUJU
Title or Position: DIRECTOR
Credential: DO
Phone: 989-752-0706