NPIMap

Organization Active NPI

Great Lakes Medical Clinic, PLLC

  • Primary Care Clinic/Center
  • Benton Harbor, MI
National Provider Identifier
1669614152
Registry record updated Mar 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
5601002947 Issued in MI
Legal business name
GREAT LAKES MEDICAL CLINIC, PLLC
Practice address
1850 Pipestone Rd
Suite 102-B
Benton Harbor, MI 49022-2304
Phone
(269) 925-8386
Fax
(269) 925-4085
NPI assigned
Mar 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2009

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

Authorized official

Name
Ms. Dawn Renee Schreckengust, PA-CNPI 1730305160
Title
President
Phone
(269) 925-8386

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 5601002947 MI Primary

Addresses

Primary practice location

1850 Pipestone Rd
Suite 102-B
Benton Harbor, MI 49022-2304

Mailing address

1850 Pipestone Rd
Suite 102-B
Benton Harbor, MI 49022-2304
Phone (269) 925-8386

National Provider Directory

National Provider Directory

Locations

1850 Pipestone Rd
Ste 102B
Benton Harbor, MI 49022
Phone (269) 925-8386

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": "1238371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238371200000",
    "number": "1669614152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 PIPESTONE RD",
            "address_2": "SUITE 102-B",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490222304",
            "telephone_number": "269-925-8386",
            "fax_number": "269-925-4085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 PIPESTONE RD",
            "address_2": "SUITE 102-B",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490222304",
            "telephone_number": "269-925-8386",
            "fax_number": "269-925-4085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES MEDICAL CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-30",
        "last_updated": "2009-03-30",
        "status": "A",
        "authorized_official_last_name": "SCHRECKENGUST",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-925-8386",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MI",
            "license": "5601002947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton Harbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2009; 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.