Healthcare Provider Details

I. General information

NPI: 1720164866
Provider Name (Legal Business Name): MCLAREN CENTRAL MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 SOUTH DR
MT PLEASANT MI
48858-3258
US

IV. Provider business mailing address

1221 SOUTH DR
MT PLEASANT MI
48858-3258
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-6700
  • Fax: 989-772-6807
Mailing address:
  • Phone: 989-772-6700
  • Fax: 989-772-6807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number StateMI

VIII. Authorized Official

Name: TARA SOULES
Title or Position: CFO
Credential:
Phone: 989-772-6720