Basic Information
| Provider Information | |||||||||
| NPI: | 1346862455 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCLAREN CENTRAL MICHIGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 SOUTH DR | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488583257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897726700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 560 W MITCHELL ST | ||||||||
| Address2: | STES 125,160,170,185,300,400,505,560,M40,C80,C70,240 | ||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497702275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314872460 | ||||||||
| FaxNumber: | 2314876596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2020 | ||||||||
| LastUpdateDate: | 10/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | SOULES | ||||||||
| AuthorizedOfficialFirstName: | TARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 9897726818 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.