Provider Demographics
NPI:1760004733
Name:MCLAREN CENTRAL MICHIGAN
Entity Type:Organization
Organization Name:MCLAREN CENTRAL MICHIGAN
Other - Org Name:MCLAREN NORTHERN MICHIGAN FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/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:989-772-6818
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:
Practice Address - Street 1:820 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2469
Practice Address - Country:US
Practice Address - Phone:231-487-3955
Practice Address - Fax:231-487-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health