1922112812 NPI number — HANNAHVILLE INDIAN COMMUNITY

Table of content: (NPI 1922112812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922112812 NPI number — HANNAHVILLE INDIAN COMMUNITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANNAHVILLE INDIAN COMMUNITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HANNAHVILLE HEALTH CENTER PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922112812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W365 US 2&41
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
WILSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-723-2560
Provider Business Mailing Address Fax Number:
906-723-2566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
W365 US 2 & 41
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
WILSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-723-2560
Provider Business Practice Location Address Fax Number:
906-723-2566
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MESHIGAUD
Authorized Official First Name:
GAYLE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF HEALTH AND HUMAN SERVIC
Authorized Official Telephone Number:
906-723-2500

Provider Taxonomy Codes

  • Taxonomy code: 332800000X , with the licence number:  5301006526 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3318839 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2043505 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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