Provider Demographics
NPI:1902841414
Name:MYMICHIGAN MEDICAL CENTER MIDLAND
Entity Type:Organization
Organization Name:MYMICHIGAN MEDICAL CENTER MIDLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEIRCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-356-7597
Mailing Address - Street 1:4000 WELLNESS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48670-0001
Mailing Address - Country:US
Mailing Address - Phone:989-839-3000
Mailing Address - Fax:
Practice Address - Street 1:4000 WELLNESS DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48670-0001
Practice Address - Country:US
Practice Address - Phone:989-839-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI560020282N00000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00257OtherBCBSM
MI1555771Medicaid
MI5171412Medicaid
MI230222Medicare Oscar/Certification