Healthcare Provider Details

I. General information

NPI: 1154357028
Provider Name (Legal Business Name): MCLAREN CENTRAL MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 SOUTH DR
MT PLEASANT MI
48858-3234
US

IV. Provider business mailing address

1221 SOUTH DR
MT PLEASANT MI
48858-3234
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 Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

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