Provider Demographics
NPI:1316719859
Name:EATON RAPIDS MEDICAL CENTER
Entity type:Organization
Organization Name:EATON RAPIDS MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, QUALITY, RISK, MED STAFF
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-663-9442
Mailing Address - Street 1:1500 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1952
Mailing Address - Country:US
Mailing Address - Phone:517-663-9442
Mailing Address - Fax:
Practice Address - Street 1:956 COOPER ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3398
Practice Address - Country:US
Practice Address - Phone:517-998-6574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EATON RAPIDS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1417044660OtherNPPES
MI1437383296OtherNPPES