Provider Demographics
NPI:1619941317
Name:MCLAREN CENTRAL MICHIGAN
Entity Type:Organization
Organization Name:MCLAREN CENTRAL MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOULES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-772-6720
Mailing Address - Street 1:1221 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3257
Mailing Address - Country:US
Mailing Address - Phone:989-772-6700
Mailing Address - Fax:989-772-1150
Practice Address - Street 1:1221 SOUTH DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3257
Practice Address - Country:US
Practice Address - Phone:989-772-6700
Practice Address - Fax:989-772-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558030Medicaid
MI00093OtherBLUE CROSS ID
MI1558030Medicaid