Basic Information
Provider Information
NPI: 1770105652
EntityType: 2
ReplacementNPI:  
OrganizationName: MCLAREN CENTRAL MICHIGAN
LastName:  
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Mailing Information
Address1: 1221 SOUTH DR
Address2:  
City: MT PLEASANT
State: MI
PostalCode: 488583257
CountryCode: US
TelephoneNumber: 9897726700
FaxNumber:  
Practice Location
Address1: 805 W CEDAR ST
Address2:  
City: STANDISH
State: MI
PostalCode: 486589526
CountryCode: US
TelephoneNumber: 9898464521
FaxNumber: 9898463546
Other Information
ProviderEnumerationDate: 05/13/2020
LastUpdateDate: 05/13/2020
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: SOULES
AuthorizedOfficialFirstName: TARA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VP/CFO
AuthorizedOfficialTelephone: 9897726818
IsSoleProprietor:  
IsOrganizationSubpart: N
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NPICertificationDate: 05/13/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QR1300X  Y Ambulatory Health Care FacilitiesClinic/CenterRural Health

No ID Information.


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