NPIMap

Organization Active NPI

McLaren Medical Group

  • Emergency Medicine Physician
  • Fenton, MI
National Provider Identifier
1164614798
Registry record updated Apr 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MCLAREN MEDICAL GROUP
Practice address
2420 Owen Rd
Fenton, MI 48430-3417
Phone
(810) 496-2400
Fax
(810) 629-0918
NPI assigned
Aug 17, 2007
Organization subpart
Yes
Parent organization
MCLAREN MEDICAL MANAGEMENTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 4, 2016

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

Authorized official

Name
Mr. William Hardimon
Title
Ceo
Phone
(810) 342-1040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

2420 Owen Rd
Fenton, MI 48430-3417

Mailing address

401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-1000

Other identifiers 1

IdentifierTypeStateIssuer
700B511870OtherMIBLUE CARE NETWORK

Other names 1

  • McLaren Medical Management, Inc Other name

National Provider Directory

National Provider Directory
Tax ID family
McLearn Services Corpor7 organizations share this tax ID, including this one
Part of
McLearn Services Corpor

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459728000000",
    "number": "1164614798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S BALLENGER HWY",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323638",
            "telephone_number": "810-342-1000",
            "fax_number": "810-342-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 OWEN RD",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484303417",
            "telephone_number": "810-496-2400",
            "fax_number": "810-629-0918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLAREN MEDICAL MANAGEMENT",
        "enumeration_date": "2007-08-17",
        "last_updated": "2016-04-04",
        "status": "A",
        "authorized_official_last_name": "HARDIMON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "810-342-1040",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "700B511870",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McLaren Medical Management, Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fenton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; 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.