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General NPI Number Information
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NPI Number | 1982677548
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Entity Type | Organization
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Legal Business Name | LAKELAND IMMEDIATE CARE CENTER
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 261 M 62
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City | CASSOPOLIS
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State | MI
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Zip | 49031-1034
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Country | US
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Telephone | 269-445-3874
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Fax | 269-445-2076
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Provider Business Mailing Address
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Address Line | 261 M 62
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City | CASSOPOLIS
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State | MI
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Zip | 49031-1034
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Country | US
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Telephone | 269-445-3874
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Fax | 269-445-2076
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Authorized Official
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Title or Position | COO
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Name | TAMMY MARIE HOWARD
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Credential |
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Telephone | 269-445-3874
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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