Provider Demographics
NPI:1134101983
Name:MYMICHIGAN MEDICAL CENTER MIDLAND
Entity Type:Organization
Organization Name:MYMICHIGAN MEDICAL CENTER MIDLAND
Other - Org Name:MYMICHIGAN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:SHERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-356-7779
Mailing Address - Street 1:6810 EASTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:989-633-0735
Practice Address - Street 1:2597 S. MERIDIAN ROAD
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-9057
Practice Address - Country:US
Practice Address - Phone:989-773-6137
Practice Address - Fax:989-773-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WH1000X
MI373510251G00000X
MI374021315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Multi-Specialty
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
08765OtherBCBS
MI08765OtherBCBS
MI2870821Medicaid
MIP96985OtherBCN
MI2870821Medicaid