Provider Demographics
NPI:1801860218
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 1:3250 E MIDLAND RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2835
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:2006-02-14
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1801860218Medicaid
MI23T041OtherMEDICARE PROVIDER NUMBER
MI2778539OtherMEDICAID PROVIDER NUMBER
MI2778539OtherMEDICAID PROVIDER NUMBER