Countryside Health Clnic LLC

NPI #1447262373 in Marion, Michigan

Provider Information

NPI Number: 1447262373
Entity Type: Organization
Organization Name: Countryside Health Clnic LLC
Primary Specialty: Nurse Practitioner
Enumeration Date: Aug 12, 2006
Last Updated: Dec 28, 2007

Practice Location

Address: 107 E MAIN STREET SUITE A
City: Marion
State: Michigan
ZIP Code: 49665
Phone: (231) 775-6076

Authorized Official

Name: TRICIA A MCGILLIS, PAC
Title: PRESIDENT
Phone: (231) 775-6076

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X
Nurse Practitioner	363L00000X	Primary

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