MEDICARE: CLINTON COUNTY MEDICAL CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101007341	MI

General Provider Information

NPI Number	:	1861486938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON COUNTY MEDICAL CENTER PC

Provider Business Mailing Address
First Line	:	1005 S US HIGHWAY 27 STE 100
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-2423
Country	:	US
Telephone Number	:	989-224-3000
Fax Number	:	989-224-1424

Provider Business Practice Location Address
First Line	:	1005 S US HIGHWAY 27 STE 100
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-2423
Country	:	US
Telephone Number	:	989-224-3000
Fax Number	:	989-224-1424

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANDREW W MESSENGER
Credential	:	DO
Telephone Number	:	989-224-3000

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	11/08/2023

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