Organization
COUNTRYSIDE HEALTH CLNIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRICIA A MCGILLIS PAC (PRESIDENT)
(231) 775-6076
Entity
Organization
Contact information
Practice address
107 E MAIN STREET SUITE A, MARION, MI 49665
(231) 775-6076
Mailing address
PO BOX 1024, CADILLAC, MI 49601-6024
(231) 775-6076
(231) 775-0024
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/12/2006
Last updated
12/28/2007
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