Medilodge of St. Clair

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

744040 Issued in MI

Legal business name

MEDILODGE OF ST. CLAIR

Practice address

4220 Hospital Dr
East China, MI 48054-2200

Phone

(810) 329-4736

Fax

(810) 329-6282

NPI assigned

Oct 4, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jana Stuever

Title

Administrator

Phone

(810) 329-4736

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Medilodge of St Clair2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Medilodge of St. Clair, Inc.

  • Skilled Nursing Facility
  • East China, MI
  • NPI 1881655777
  NPD tax ID

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1427045442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 HOSPITAL DR",
            "city": "EAST CHINA",
            "state": "MI",
            "postal_code": "480542200",
            "telephone_number": "810-329-4736",
            "fax_number": "810-329-6282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4220 HOSPITAL DR",
            "city": "EAST CHINA",
            "state": "MI",
            "postal_code": "480542200",
            "telephone_number": "810-329-4736",
            "fax_number": "810-329-6282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDILODGE OF ST. CLAIR",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STUEVER",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "810-329-4736"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "744040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2630271",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark T. O'Brien, D.O., P.C.
• Julie Marquette
• Silvana Dhia Matte, M.D.
• Renee C McNeill, CRNA
• Medflex P.C
• Medilodge of St. Clair, Inc.
• Laurie Meyers
• Michael Solomon Chiropractic, PLLC
• Monica Ziezulewicz Osentoski, R.PH.
• Judy Lynn Radyko

• Skilled Nursing Facility in East China, MI
• Providers in East China, MI by specialty
• Skilled Nursing Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.