Basic Information
| Provider Information | |||||||||
| NPI: | 1013188473 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCLAREN GREATER LANSING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 W GREENLAWN AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489102819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179756000 | ||||||||
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| Address1: | 401 W GREENLAWN AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179756000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2008 | ||||||||
| LastUpdateDate: | 08/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | DALE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5179757555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.