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Organization Active NPI

Mymichigan Medical Center Gladwin

  • Rural Health Clinic/Center
  • Gladwin, MI
National Provider Identifier
1093044067
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MYMICHIGAN MEDICAL CENTER GLADWIN
Practice address
1105 E Cedar Ave
Gladwin, MI 48624-7003
Phone
(989) 246-6201
NPI assigned
Dec 21, 2009
Last updated
Jan 15, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MYMICHIGAN MEDICAL CENTER GLADWINAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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

Authorized official

Name
Sarah James
Title
Manager, Provider Enrollment
Phone
(989) 701-4734

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

1105 E Cedar Ave
Gladwin, MI 48624-7003

Mailing address

4000 Wellness Dr
Midland, MI 48670-2000
Phone (844) 832-1956

Other identifiers 1

IdentifierTypeStateIssuer
23-8641OtherMIMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100802000319 MI Part A Provider - Rural Health Clinic 0143262915 Practice locations: Gladwin, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093044067. Details of each certification follow.

Rural health clinic certification: CCN 238641

Legal name
MYMICHIGAN MEDICAL CENTER GLADWIN
Doing business as
MYMICHIGAN HEALTH PARK GLADWIN
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 15, 2011
Last certification
Jun 12, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
1105 E Cedar Ave
Gladwin, MI 48624-7003
Related CCNs
231325

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Midmichigan Med Ctr Gladwin14 organizations share this tax ID, including this one
Part of
Midmichigan Med Ctr Gladwin

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sarah James Individual Corporate OfficerManager of Operations, Pe Jul 1, 2025
Raymond H Stover Individual Corporate DirectorPresident Jan 13, 2013
W-2 Managing EmployeePresident Jan 10, 2013
Lydia Watson Individual Corporate Director Dec 1, 2022
W-2 Managing Employee Dec 1, 2022
Samantha Hunter Individual W-2 Managing Employee Jan 1, 2023
Mymichigan Health Organization, Midland, MI Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2016 100%
Tricia Gorde Individual Corporate DirectorDirector of Operations Jan 20, 2025

Facilities with the same owner 30

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1261353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768435200000",
    "number": "1093044067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 WELLNESS DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486702000",
            "telephone_number": "844-832-1956",
            "fax_number": "989-633-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 E CEDAR AVE",
            "city": "GLADWIN",
            "state": "MI",
            "postal_code": "486247003",
            "telephone_number": "989-246-6201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYMICHIGAN MEDICAL CENTER GLADWIN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MYMICHIGAN MEDICAL CENTER GLADWIN",
        "enumeration_date": "2009-12-21",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "MANAGER, PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "989-701-4734"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "23-8641",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gladwin, MI

Sources for this page

Verify at the official NPI Registry.