Provider Demographics
NPI:1073650750
Name:MCLAREN MEDICAL GROUP
Entity Type:Organization
Organization Name:MCLAREN MEDICAL GROUP
Other - Org Name:MCLAREN MEDICAL MANAGMENT, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-342-1040
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:1254 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1343
Practice Address - Country:US
Practice Address - Phone:810-664-4531
Practice Address - Fax:810-667-7337
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLAREN MEDICAL MANAGEMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI310B510720OtherBLUE CROSS BLUE SHIELD
MI310B510720OtherBLUE CROSS BLUE SHIELD