# MCLAREN PRIMARY CARE

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

## Provider details

- **NPI number:** 1972894566
- **Authorized official:** DANIELLE C JACKS PORTER (VP/CFO)
- **Authorized official phone:** (989) 894-3838

## Contact information

- **Practice address:** 1807 M-55, WEST BRANCH, MI 48661-0000
- **Practice address phone:** (989) 345-0945
- **Practice address fax:** (989) 345-2831
- **Mailing address:** 1900 COLUMBUS AVE, ATTN: MCLAREN BAY REGION CEO, BAY CITY, MI 48708-6831

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 4301062477 | MI | — |
| 363A00000X | Physician Assistant | 5601005840 | MI | Yes |
| 363LF0000X | Family Nurse Practitioner | 4704214196 | MI | — |

## Other

- **Enumeration date:** 04/29/2011
- **Last updated:** 05/22/2019