Basic Information
| Provider Information | |||||||||
| NPI: | 1760574883 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MYMICHIGAN MEDICAL CENTER ALMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 WELLNESS DR | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486702000 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 E. WARWICK DRIVE | ||||||||
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| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894631101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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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: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 700B96013 | 01 | MI | BCBSM | OTHER | CI7713 | 01 | MI | MEDICARE RAILROAD | OTHER | CI3598 | 01 | MI | MEDICARE RAILRAOD | OTHER | DA1187 | 01 | MI | MEDICARE RAILROAD | OTHER | CC4423 | 01 | MI | MEDICARE RAILROAD | OTHER | DB0163 | 01 | MI | MEDICARE RAILROAD | OTHER | CH5245 | 01 | MI | MEDICARE RAILROAD | OTHER | CN7873 | 01 | MEDICARE RAILROAD | OTHER |