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General NPI Number Information
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NPI Number | 1205889490
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Entity Type | Organization
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Legal Business Name | MYMICHIGAN MEDICAL CENTER MIDLAND
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 4000 WELLNESS DR
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City | MIDLAND
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State | MI
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Zip | 48670-2000
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Country | US
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Telephone | 844-832-1956
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 WELLNESS DR, PROVIDER ENROLLMENT
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City | MIDLAND
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State | MI
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Zip | 48670
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Country | US
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Telephone | 844-832-1956
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRYAN REX CROSS
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Credential |
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Telephone | 989-839-1322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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