# COUNTRYSIDE HEALTH CLNIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447262373
- **Authorized official:** TRICIA A MCGILLIS PAC (PRESIDENT)
- **Authorized official phone:** (231) 775-6076

## Contact information

- **Practice address:** 107 E MAIN STREET SUITE A, MARION, MI 49665
- **Practice address phone:** (231) 775-6076
- **Mailing address:** PO BOX 1024, CADILLAC, MI 49601-6024
- **Mailing address phone:** (231) 775-6076
- **Mailing address fax:** (231) 775-0024

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/12/2006
- **Last updated:** 12/28/2007