Provider Demographics
NPI:1376564088
Name:MCLAREN OAKLAND
Entity Type:Organization
Organization Name:MCLAREN OAKLAND
Other - Org Name:PONTIAC OSTEOPATHIC HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-338-5691
Mailing Address - Street 1:50 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2217
Mailing Address - Country:US
Mailing Address - Phone:248-338-5000
Mailing Address - Fax:248-338-5262
Practice Address - Street 1:50 N PERRY ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2217
Practice Address - Country:US
Practice Address - Phone:248-338-5000
Practice Address - Fax:248-338-5262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI630120273R00000X, 273Y00000X, 282N00000X
MI631247276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No273Y00000XHospital UnitsRehabilitation Unit
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00213OtherBLUECROSS ACUTE CARE HOS
FL134124300OtherDOL OWCP FECA
MI5171673Medicaid
MI1557696Medicaid
MI20214OtherBLUE CROSS IP SUBSTANCE ABUSE UNIT
MI20214OtherBLUE CROSS IP SUBSTANCE ABUSE UNIT
MI23T207Medicare Oscar/Certification
MI5171673Medicaid