Provider Demographics
NPI:1124221478
Name:MCLAREN GREATER LANSING
Entity Type:Organization
Organization Name:MCLAREN GREATER LANSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-975-7555
Mailing Address - Street 1:840 E MOUNT HOPE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3293
Mailing Address - Country:US
Mailing Address - Phone:517-487-2273
Mailing Address - Fax:517-487-2268
Practice Address - Street 1:840 E MOUNT HOPE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-487-2273
Practice Address - Fax:517-487-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI330C313780OtherBLUE CROSS BLUE SHIELD
MI330C313780OtherBLUE CROSS BLUE SHIELD