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General NPI Number Information
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NPI Number | 1184238966
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Entity Type | Organization
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Legal Business Name | MED CLUBS
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 05/12/2024
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Provider Practice Location Address
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Address Line | 120 N WASHINGTON SQ STE 300
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City | LANSING
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State | MI
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Zip | 48933-1658
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Country | US
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Telephone | 517-258-0344
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Fax | 517-879-0374
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Provider Business Mailing Address
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Address Line | 120 N WASHINGTON SQ STE 300
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City | LANSING
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State | MI
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Zip | 48933-1658
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Country | US
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Telephone | 517-258-0344
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HARSHINI A JAYASURIYA
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Credential | MD
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Telephone | 517-258-0344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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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 | 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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