Healthcare Provider Details

I. General information

NPI: 1093629917
Provider Name (Legal Business Name): EATON RAPIDS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 PATIENT CARE DR
LANSING MI
48911-4299
US

IV. Provider business mailing address

1500 S MAIN ST
EATON RAPIDS MI
48827-1952
US

V. Phone/Fax

Practice location:
  • Phone: 517-663-9403
  • Fax: 517-663-8615
Mailing address:
  • Phone: 517-663-9403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CAROLYN SHAW
Title or Position: PROVIDER ENROLLMENT & MED STAFF
Credential:
Phone: 517-663-9446