Healthcare Provider Details

I. General information

NPI: 1679506851
Provider Name (Legal Business Name): MYMICHIGAN MEDICAL CENTER ALMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 N PINE RIVER ST
ITHACA MI
48847-1118
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-0001
US

V. Phone/Fax

Practice location:
  • Phone: 989-875-3722
  • Fax: 989-875-8903
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMI

VIII. Authorized Official

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