| Organization Name: | GRAND TRAVERSE BAND OF OTTAWA AND CHIPEWA INDIANS |
| NPI Number: | 1134281132 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LOI E. CHAMBERS (BUSINESS MANAGER) |
| Mailing Address: | 2300 N Stallman Rd Suttons Bay |
| State: | MI US |
| Postal Code: | 496829158 |
| Phone Number: | 2315347200 |
| Fax Number: | 2315347460 |
| NPI Enumeration Date: | 12/15/2006 |
| NPI Last Update Date: | 11/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |