Healthcare Provider Details

I. General information

NPI: 1447701008
Provider Name (Legal Business Name): LAKELAND IMMEDIATE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 OAK ST
NILES MI
49120-3738
US

IV. Provider business mailing address

261 M 62
CASSOPOLIS MI
49031-1034
US

V. Phone/Fax

Practice location:
  • Phone: 269-262-4364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TAMMY MARIE HOWARD
Title or Position: COO
Credential:
Phone: 269-445-3874