Basic Information
| Provider Information | |||||||||
| NPI: | 1205889490 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MYMICHIGAN MEDICAL CENTER MIDLAND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 WELLNESS DR, PROVIDER ENROLLMENT | ||||||||
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| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8448321956 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4000 WELLNESS DR | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486702000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8448321956 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | CROSS | ||||||||
| AuthorizedOfficialFirstName: | BRYAN | ||||||||
| AuthorizedOfficialMiddleName: | REX | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9898391322 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207T00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.