MEDICARE: MCLAREN ASC OF FLINT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1124142781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLAREN ASC OF FLINT, LLC

Provider Business Mailing Address
First Line	:	501 SOUTH BALLENGER HIGHWAY
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48532-3641
Country	:	US
Telephone Number	:	810-768-2044
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 SOUTH BALLENGER HIGHWAY
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48532-3641
Country	:	US
Telephone Number	:	810-768-2044
Fax Number	:

Authorized Official
Title or Position	:	OFFICER, AUTHORIZED OFFICIAL, MEDIC
Name	:	KATHERINE L. REED
Credential	:
Telephone Number	:	972-763-3859

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	03/17/2010

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