# CENTRAL MICHIGAN UNIVERSITY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 1588897896
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1447606801
- **Legal business name:** 1588897896
- **Authorized official:** MATTHEW JACKSON (ATHLETIC DIRECTOR)
- **Authorized official phone:** (989) 774-7657

## Contact information

- **Practice address:** CMU SPORTS MEDICINE, ROSE 100, MT PLEASANT, MI 48859-0001
- **Practice address phone:** (989) 774-2281
- **Practice address fax:** (989) 774-1095
- **Mailing address:** CMU SPORTS MEDICINE, ROSE 100, MT PLEASANT, MI 48859-0001
- **Mailing address phone:** (989) 774-2281
- **Mailing address fax:** (989) 774-1095

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 5101018472 | MI | Yes |

## Other

- **Enumeration date:** 05/04/2016
- **Last updated:** 05/27/2016