Provider Demographics
NPI:1295972875
Name:MCLAREN OWOSSO CANCER CENTER
Entity type:Organization
Organization Name:MCLAREN OWOSSO CANCER CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-342-2446
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-2446
Mailing Address - Fax:810-342-2428
Practice Address - Street 1:826 W KING ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2120
Practice Address - Country:US
Practice Address - Phone:810-342-2446
Practice Address - Fax:810-342-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation