Healthcare Provider Details

I. General information

NPI: 1215550645
Provider Name (Legal Business Name): MCLAREN CENTRAL MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 LOCKWOOD LN
MIO MI
48647-9387
US

IV. Provider business mailing address

1221 SOUTH DR
MT PLEASANT MI
48858-3257
US

V. Phone/Fax

Practice location:
  • Phone: 989-826-3271
  • Fax: 989-826-6749
Mailing address:
  • Phone: 989-772-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TARA SOULES
Title or Position: VP/CFO
Credential:
Phone: 989-772-6818