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General NPI Number Information
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NPI Number | 1053690438
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Entity Type | Organization
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Legal Business Name | MCLAREN BAY REGION
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 558 LOCKWOOD LN
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City | MIO
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State | MI
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Zip | 48647
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Country | US
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Telephone | 989-826-3271
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Fax | 989-826-6749
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Provider Business Mailing Address
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Address Line | 558 LOCKWOOD LN PO BOX 460
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City | MIO
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State | MI
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Zip | 48647-9387
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Country | US
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Telephone | 989-826-3271
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Fax | 989-826-6749
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Authorized Official
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Title or Position | CFO
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Name | DANIELLE C JACKS PORTER
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Credential |
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Telephone | 989-894-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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