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General NPI Number Information
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NPI Number | 1891609806
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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 | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 1035 CHARLEVOIX DR STE 100
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City | GRAND LEDGE
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State | MI
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Zip | 48837-2223
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Country | US
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Telephone | 517-663-9403
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Fax | 517-663-8615
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Provider Business Mailing 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 | 517-663-9403
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT AND MED STAFF
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Name | CAROLYN SHAW
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Credential |
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Telephone | 517-663-9446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NULL
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