MEDICARE: MCLAREN PRIMARY CARE

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1710916853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLAREN PRIMARY CARE

Provider Business Mailing Address
First Line	:	1900 COLUMBUS AVE
Second Line	:	ATTN: MCLAREN BAY REGION CEO
City	:	BAY CITY
State	:	MI
Zip	:	48708-6831
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 N SAINT HELEN RD
Second Line	:
City	:	SAINT HELEN
State	:	MI
Zip	:	48656-9521
Country	:	US
Telephone Number	:	989-389-4944
Fax Number	:	989-389-1401

Authorized Official
Title or Position	:	VP/CFO
Name	:	DANIELLE C JACKS PORTER
Credential	:
Telephone Number	:	989-894-3838

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	05/22/2019

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Directions to “MCLAREN PRIMARY CARE ” Practice Location

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