Healthcare Provider Details

I. General information

NPI: 1750309209
Provider Name (Legal Business Name): MYMICHIGAN MEDICAL CENTER ALMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E WARWICK DR SUITE C
ALMA MI
48801-1083
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-0001
US

V. Phone/Fax

Practice location:
  • Phone: 989-463-9307
  • Fax: 989-463-9369
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: AMANDA M PEIRCE
Title or Position: MANAGER PATIENT ACCOUNTS
Credential:
Phone: 989-356-7597