Basic Information
| Provider Information | |||||||||
| NPI: | 1528097672 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCLAREN PRIMARY CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 COLUMBUS AVE | ||||||||
| Address2: | ATTN: MCLAREN BAY REGION CEO | ||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487086831 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2990 CAMPBELL RD | ||||||||
| Address2: | |||||||||
| City: | ROSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486549724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896852333 | ||||||||
| FaxNumber: | 9896852760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | JACKS PORTER | ||||||||
| AuthorizedOfficialFirstName: | DANIELLE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | VP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 9898943838 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.