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General NPI Number Information
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NPI Number | 1588810709
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Entity Type | Organization
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Legal Business Name | EATON RAPIDS MEDICAL CENTER
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 1500 S MAIN ST
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City | EATON RAPIDS
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State | MI
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Zip | 48827-1952
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Country | US
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Telephone | 517-857-4500
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Fax | 517-857-4510
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Provider Business Mailing Address
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Address Line | 400 E MAIN ST SUITE 200
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City | SPRINGPORT
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State | MI
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Zip | 49284-9774
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Country | US
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Telephone | 517-857-4500
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Fax | 517-857-4510
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | TIMOTHY J. JOHNSON
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Credential | CPA
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Telephone | 517-663-9474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 230010
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License Number State | MI
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