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1215 E Michigan Ave Lansing MI 48912-1811 | |
| (517) 364-7700 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1215 E Michigan Ave, Lansing, Michigan |
| Authorized Official Name and Position | Misty Russian (SUPERVISOR, PROVIDER ENROLLMENT) |
| Authorized Official Contact | 5172536308 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8175 Reliable Pkwy Chicago IL 60686-0081 Ph: (517) 364-6000 | 1215 E Michigan Ave Lansing MI 48912-1811 Ph: (517) 364-7700 |
| NPI Number | 1669431292 |
|---|---|
| Provider Enumeration Date | 03/22/2006 |
| Last Update Date | 02/28/2024 |
| Certification Date | 02/28/2024 |
| Medicare PECOS PAC ID | 6709799166 |
|---|---|
| Medicare Enrollment ID | O20070222000307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669431292 | NPI | - | NPPES |
| 200000000005 | Other | MI | PHP FAMILY CARE |
| 30-1557293 | Medicaid | MI | |
| 00025 | Other | MI | BLUE CROSS/BCN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | PH-040/2005(2) (Michigan) | Primary |
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