Organization Name: | UPPER GREAT LAKES FAMILY HEALTH CENTER |
NPI Number: | 1508289273 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DONALD A SIMILA (CEO) |
Mailing Address: | 1500 W Ice Lake Road Iron River |
State: | MI US |
Postal Code: | 499358509 |
Phone Number: | 9062655378 |
Fax Number: | 9062654245 |
NPI Enumeration Date: | 01/30/2014 |
NPI Last Update Date: | 04/18/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |