Healthcare Provider Details

I. General information

NPI: 1588285415
Provider Name (Legal Business Name): MCLAREN CENTRAL MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

406 KENT ST
PORTLAND MI
48875-1707
US

IV. Provider business mailing address

1221 SOUTH DR
MT PLEASANT MI
48858-3257
US

V. Phone/Fax

Practice location:
  • Phone: 517-647-4166
  • Fax: 517-647-2473
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