MEDICARE: MCLAREN PORT HURON

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	282N00000X	General Acute Care Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7509106270	OTHER	MI	OPC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982685384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLAREN PORT HURON

Provider Business Mailing Address
First Line	:	1221 PINE GROVE AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 PINE GROVE AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3511
Country	:	US
Telephone Number	:	810-987-5000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ERIC SCOTT CECAVA
Credential	:
Telephone Number	:	810-989-3704

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	04/15/2022

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1053387035 — MICHAEL K PAUL M.D.
Practice Location Address:

1221 PINE GROVE AVE , MCLAREN PORT HURON - EMERGENCY MEDICINE DEPARTMENT
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48060-3511

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1316913437 — CHRISTOPHER A HUNT M.D.
Practice Location Address:

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PORT HURON, MI
48060-3511

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1841266806 — MARC RICHARD CONNELY JONES D.O.
Practice Location Address:

1221 PINE GROVE AVE , MCLAREN PORT HURON - EMERGENCY MEDICINE DEPARTMENT
PORT HURON, MI
48060-3511

Practice Phone: 810-989-3300
Practice Fax: 810-985-2671

Directions to “MCLAREN PORT HURON ” Practice Location

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