Provider Demographics
NPI:1528031226
Name:MCLAREN BAY REGION
Entity Type:Organization
Organization Name:MCLAREN BAY REGION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JACKS PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-894-3838
Mailing Address - Street 1:1900 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6831
Mailing Address - Country:US
Mailing Address - Phone:989-894-3000
Mailing Address - Fax:989-891-8172
Practice Address - Street 1:1900 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708
Practice Address - Country:US
Practice Address - Phone:989-894-3000
Practice Address - Fax:989-891-8172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-12
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI230041OtherMEDICARE PROVIDER NUMBER
MI00004OtherBCBSM PROVIDER NUMBER
MI1528031226Medicaid
MI5170101OtherMEDICAID PROVIDER NUMBER
MI1556302OtherMEDICAID PROVIDER NUMBER
MI230041Medicare Oscar/Certification