Healthcare Provider Details

I. General information

NPI: 1184238966
Provider Name (Legal Business Name): MED CLUBS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 05/12/2024
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N WASHINGTON SQ STE 300
LANSING MI
48933-1658
US

IV. Provider business mailing address

120 N WASHINGTON SQ STE 300
LANSING MI
48933-1658
US

V. Phone/Fax

Practice location:
  • Phone: 517-258-0344
  • Fax: 517-879-0374
Mailing address:
  • Phone: 517-258-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HARSHINI A JAYASURIYA
Title or Position: OWNER
Credential: MD
Phone: 517-258-0344