Organization
EATON RAPIDS MEDICAL CENTER
Active
Parent organization
EATON RAPIDS MEDICAL CENTER
Other names
Springport Medical Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
EATON RAPIDS MEDICAL CENTER
Authorized official
TIMOTHY J. JOHNSON CPA (CHIEF EXECUTIVE OFFICER)
(517) 663-9474
Entity
Organization
Contact information
Practice address
1500 S MAIN ST, EATON RAPIDS, MI 48827-1952
(517) 857-4500
(517) 857-4510
Mailing address
400 E MAIN ST, SUITE 200, SPRINGPORT, MI 49284-9774
(517) 857-4500
(517) 857-4510
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
230010
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5170569
—
MI
01
—
OB37608
MEDICARE PTAN
MI
Enumeration date
08/08/2008
Last updated
03/02/2022
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