Healthcare Provider Details

I. General information

NPI: 1932154457
Provider Name (Legal Business Name): MYMICHIGAN MEDICAL CENTER CLARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N MAIN ST
EVART MI
49631
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 231-734-3300
  • Fax:
Mailing address:
  • Phone: 989-839-3314
  • Fax: 989-839-1563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

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