Basic Information
| Provider Information | |||||||||
| NPI: | 1073999298 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MYMICHIGAN MEDICAL CENTER GLADWIN | ||||||||
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| OtherOrganizationName: | EMERGENCY ROOM PHYSICIANS OF CLARE AND GLADWIN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 WELLNESS DR | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486702000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896335200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 515 QUARTER ST | ||||||||
| Address2: | |||||||||
| City: | GLADWIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486241959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894269286 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2015 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | PEIRCE | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER PATIENT ACCOUNTS | ||||||||
| AuthorizedOfficialTelephone: | 9893567597 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.