MEDICARE: MYMICHIGAN MEDICAL CENTER MIDLAND

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	163WH1000X	Hospice Registered Nurse
2	315D00000X	Inpatient Hospice	374021	MI
3	251G00000X	Community Based Hospice Care Agency	373510	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08765	OTHER		BCBS
2	08765	OTHER	MI	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P96985	OTHER	MI	BCN

General Provider Information

NPI Number	:	1134101983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYMICHIGAN MEDICAL CENTER MIDLAND

Provider Business Mailing Address
First Line	:	4000 WELLNESS DR
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48670-2000
Country	:	US
Telephone Number	:	844-832-1956
Fax Number	:	989-633-5241

Provider Business Practice Location Address
First Line	:	2597 S. MERIDIAN ROAD
Second Line	:
City	:	MT. PLEASANT
State	:	MI
Zip	:	48858-9057
Country	:	US
Telephone Number	:	989-773-6137
Fax Number	:	989-773-1072

Authorized Official
Title or Position	:	MANAGER, PROVIDER ENROLLMENT
Name	:	SARAH JAMES
Credential	:
Telephone Number	:	989-701-4734

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	01/14/2026

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Directions to “MYMICHIGAN MEDICAL CENTER MIDLAND ” Practice Location

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