Provider Demographics
NPI:1972191278
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:989-772-6818
Mailing Address - Street 1:PO BOX 775361
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5361
Mailing Address - Country:US
Mailing Address - Phone:269-973-1298
Mailing Address - Fax:
Practice Address - Street 1:116 W MITCHELL ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2357
Practice Address - Country:US
Practice Address - Phone:231-348-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health