Provider Demographics
NPI:1871306167
Name:MID-MICHIGAN SPECIALTY CLINICS PLLC
Entity type:Organization
Organization Name:MID-MICHIGAN SPECIALTY CLINICS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-498-4770
Mailing Address - Street 1:8203 S SAGINAW ST STE E
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2434
Mailing Address - Country:US
Mailing Address - Phone:810-498-4770
Mailing Address - Fax:
Practice Address - Street 1:8203 S SAGINAW ST STE E
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2434
Practice Address - Country:US
Practice Address - Phone:810-498-4770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies