Basic Information
Provider Information
NPI: 1790928240
EntityType: 2
ReplacementNPI:  
OrganizationName: MYMICHIGAN MEDICAL CENTER ALMA
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: MIDMICHIGAN URGENT CARE ALMA
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4000 WELLNESS DR
Address2:  
City: MIDLAND
State: MI
PostalCode: 486700001
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 321 E WARWICK DR
Address2:  
City: ALMA
State: MI
PostalCode: 488011084
CountryCode: US
TelephoneNumber: 9894663348
FaxNumber: 9894662970
Other Information
ProviderEnumerationDate: 04/14/2009
LastUpdateDate: 10/18/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: PEIRCE
AuthorizedOfficialFirstName: AMANDA
AuthorizedOfficialMiddleName: M
AuthorizedOfficialTitleorPosition: MANAGER PATIENT ACCOUNTS
AuthorizedOfficialTelephone: 9893567597
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/18/2022

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

No ID Information.


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