Provider Demographics
NPI:1477654234
Name:MYMICHIGAN MEDICAL CENTER ALMA
Entity Type:Organization
Organization Name:MYMICHIGAN MEDICAL CENTER ALMA
Other - Org Name:ST. LOUIS FAMILY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEIRCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-356-7597
Mailing Address - Street 1:4000 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48670-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:224 N MILL ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880-1523
Practice Address - Country:US
Practice Address - Phone:989-681-3524
Practice Address - Fax:989-681-2683
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYMICHIGAN MEDICAL CENTER ALMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-26
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B91072OtherBCBSM
MI1020574OtherMCLAREN
MIDF2454Medicare PIN
MI1020574OtherMCLAREN
MI0P33470Medicare PIN