1588727671 NPI number — MACKINAC STRAITS HOSPITAL & HEALTH CENTER

Table of content: (NPI 1588727671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588727671 NPI number — MACKINAC STRAITS HOSPITAL & HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MACKINAC STRAITS HOSPITAL & HEALTH CENTER
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:
MACKINAC ISLAND MEDICAL CENTER
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:
1588727671
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 BURDETTE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT IGNACE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49781-1712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-643-8585
Provider Business Mailing Address Fax Number:
906-643-0373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MARKET ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACKINAC ISLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49757-0536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-847-3582
Provider Business Practice Location Address Fax Number:
906-847-6490
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
906-643-0455

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 700D96239 . This is a "BLUE CROSS BSM GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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