Provider Demographics
NPI:1619229663
Name:MYMICHIGAN MEDICAL CENTER CLARE
Entity Type:Organization
Organization Name:MYMICHIGAN MEDICAL CENTER CLARE
Other - Org Name:MIDMICHIGAN MEDICAL OFFICES SANFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-246-6201
Mailing Address - Street 1:4000 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48670-2000
Mailing Address - Country:US
Mailing Address - Phone:989-687-9940
Mailing Address - Fax:989-687-9945
Practice Address - Street 1:40 W SAGINAW RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:MI
Practice Address - Zip Code:48657-9206
Practice Address - Country:US
Practice Address - Phone:989-687-9940
Practice Address - Fax:989-687-9945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYMICHIGAN MEDICAL CENTER CLARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-15
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health