Provider Demographics
NPI:1275253874
Name:LAUREN OBERG LLC
Entity Type:Organization
Organization Name:LAUREN OBERG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER/BILLER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-442-3341
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0337
Mailing Address - Country:US
Mailing Address - Phone:517-442-3341
Mailing Address - Fax:
Practice Address - Street 1:1724 BLAIR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-1101
Practice Address - Country:US
Practice Address - Phone:517-442-3341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health