NPIMap

Organization Active NPI

McLaren Northern Michigan

  • Institutional Pharmacy
  • Petoskey, MI
National Provider Identifier
1083771364
Registry record updated Dec 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
5301002202 Issued in MI
Legal business name
MCLAREN NORTHERN MICHIGAN
Practice address
416 Connable Ave
Petoskey, MI 49770-2212
Phone
(231) 487-4843
Fax
(231) 487-4817
NPI assigned
Jan 3, 2007
Last updated
Dec 19, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kevin Pendleton, RPH
Title
Pharmacy Manager
Phone
(231) 487-4843

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X 5301002202 MI Primary

Addresses

Primary practice location

416 Connable Ave
Petoskey, MI 49770-2212

Mailing address

416 Connable Ave
Petoskey, MI 49770-2212
Phone (231) 487-4843

Other identifiers 2

IdentifierTypeStateIssuer
2324349OtherNCPDP NUMBER
5171539MedicaidMI

Other names 1

  • Northern Michigan Regional Hospital Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
No Mi Hosprogers City4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513641600000",
    "number": "1083771364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 CONNABLE AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702212",
            "telephone_number": "231-487-4843",
            "fax_number": "231-487-4817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 CONNABLE AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702212",
            "telephone_number": "231-487-4843",
            "fax_number": "231-487-4817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN NORTHERN MICHIGAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2017-12-19",
        "status": "A",
        "authorized_official_last_name": "PENDLETON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "231-487-4843",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "MI",
            "license": "5301002202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "2324349",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5171539",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Michigan Regional Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Petoskey, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.