Basic Information
| Provider Information | |||||||||
| NPI: | 1407297104 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDMICHIGAN MEDICAL CENTER CLARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 N MCEWAN ST | ||||||||
| Address2: | |||||||||
| City: | CLARE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486171440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898025000 | ||||||||
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| Address1: | 703 N MCEWAN ST | ||||||||
| Address2: | |||||||||
| City: | CLARE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486171440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898025000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2013 | ||||||||
| LastUpdateDate: | 07/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | STOVER | ||||||||
| AuthorizedOfficialFirstName: | RAYMOND | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9898025102 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.