Healthcare Provider Details

I. General information

NPI: 1104225168
Provider Name (Legal Business Name): MCLAREN GREATER LANSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3937 PATIENT CARE WAY #106
LANSING MI
48911
US

IV. Provider business mailing address

401 W GREENLAWN AVE
LANSING MI
48910-2819
US

V. Phone/Fax

Practice location:
  • Phone: 517-485-2317
  • Fax: 517-485-1490
Mailing address:
  • Phone: 517-975-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DALE THOMPSON
Title or Position: CFO
Credential:
Phone: 517-975-7555