Provider Demographics
NPI:1558556332
Name:MCLAREN GREATER LANSING
Entity Type:Organization
Organization Name:MCLAREN GREATER LANSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-975-7555
Mailing Address - Street 1:2111 UNIVERISTY PARK DR
Mailing Address - Street 2:STE 800
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864
Mailing Address - Country:US
Mailing Address - Phone:517-908-0039
Mailing Address - Fax:517-908-0038
Practice Address - Street 1:401 W GREENLAWN AVE STE 110
Practice Address - Street 2:INGHAM REGIONAL MEDICAL CENTER
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-334-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI064510103T00000X
208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3375736Medicaid
MI4327359Medicaid
MI4402874Medicaid
MI4363604Medicaid
MI4327359Medicaid
MIE98123Medicare UPIN
MI4363604Medicaid
MI0C36173Medicare PIN
MIF45977Medicare UPIN
MI0M92900Medicare PIN