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General NPI Number Information
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NPI Number | 1972894566
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Entity Type | Organization
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Legal Business Name | MCLAREN PRIMARY CARE
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Dates
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Enumeration Date | 04/29/2011
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 1807 M-55
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City | WEST BRANCH
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State | MI
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Zip | 48661-0000
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Country | US
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Telephone | 989-345-0945
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Fax | 989-345-2831
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Provider Business Mailing Address
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Address Line | 1900 COLUMBUS AVE ATTN: MCLAREN BAY REGION CEO
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City | BAY CITY
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State | MI
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Zip | 48708-6831
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP/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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301062477
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License Number State | MI
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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 | 4704214196
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601005840
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License Number State | MI
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