Provider Demographics
NPI:1487686754
Name:CENTRAL MICHIGAN UNIVERSITY
Entity Type:Organization
Organization Name:CENTRAL MICHIGAN UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH INFO SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:STITES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-774-6599
Mailing Address - Street 1:202 FOUST HL
Mailing Address - Street 2:CENTRAL MICHIGAN UNIVERSITY HEALTH SERVICES
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48859-0001
Mailing Address - Country:US
Mailing Address - Phone:989-774-6599
Mailing Address - Fax:989-774-4335
Practice Address - Street 1:202 FOUST HALL
Practice Address - Street 2:CENTRAL MICHIGAN UNIVERSITY HEALTH SERVICES
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48859-0001
Practice Address - Country:US
Practice Address - Phone:989-774-1748
Practice Address - Fax:989-774-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 208600000X
MI207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C76005OtherBCBS NUMBER
MI0C76005OtherBCBS NUMBER