| Organization Name: | KEWEENAW BAY INDIAN COMMUNITY MIHP PROGRAM |
| NPI Number: | 1134363609 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOEL BRUCE MILLS (MEDICAL BILLING SPECIALIST) |
| Mailing Address: | 102 Superior Ave Baraga |
| State: | MI US |
| Postal Code: | 499089673 |
| Phone Number: | 9063534542 |
| Fax Number: | 9063538799 |
| NPI Enumeration Date: | 04/28/2009 |
| NPI Last Update Date: | 04/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |