Organization Name: | BAY MILLS INDIAN COMMUNITY |
NPI Number: | 1851358873 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PARKER GREG (CFO) |
Mailing Address: | 12124 W Lakeshore Dr Brimley |
State: | MI US |
Postal Code: | 497159319 |
Phone Number: | 9062485579 |
Fax Number: | 9062485765 |
NPI Enumeration Date: | 04/26/2006 |
NPI Last Update Date: | 08/24/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | OA76020 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |