1437166022 NPI number — MCLAREN CENTRAL MICHIGAN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437166022 NPI number — MCLAREN CENTRAL MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCLAREN CENTRAL MICHIGAN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437166022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 SOUTH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48858-3258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-772-6700
Provider Business Mailing Address Fax Number:
989-772-6807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 SOUTH DR
Provider Second Line Business Practice Location Address:
STES 131, 341, 352, 371
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48858-3256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-779-5250
Provider Business Practice Location Address Fax Number:
989-779-5251
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOULES
Authorized Official First Name:
TARA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/CFO
Authorized Official Telephone Number:
989-772-6720

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1437166022 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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