Organization
MCLAREN MACOMB
Active
Parent organization
MT. CLEMENS GENERAL HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
MT. CLEMENS GENERAL HOSPITAL
Authorized official
MR. THOMAS M BRISSE (CEO)
(586) 493-8083
Entity
Organization
Contact information
Practice address
1000 HARRINGTON ST, MOUNT CLEMENS, MI 48043
(586) 493-8000
Mailing address
401 S BALLENGER HWY, FLINT, MI 48532-3638
(810) 342-1000
(810) 342-1590
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E06116
BLUE CROSS BLUE SHIELD
MI
Enumeration date
02/05/2008
Last updated
05/23/2018
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