Healthcare Provider Details

I. General information

NPI: 1619229663
Provider Name (Legal Business Name): MYMICHIGAN MEDICAL CENTER CLARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W SAGINAW RD
SANFORD MI
48657-9206
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 989-687-9940
  • Fax: 989-687-9945
Mailing address:
  • Phone: 989-687-9940
  • Fax: 989-687-9945

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: RAYMOND STOVER
Title or Position: PRESIDENT
Credential:
Phone: 989-246-6201