1518922525 NPI number — SAULT TRIBE OF CHIPPEWA INDIANS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518922525 NPI number — SAULT TRIBE OF CHIPPEWA INDIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAULT TRIBE OF CHIPPEWA INDIANS
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:
SAULT TRIBAL HEALTH 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:
1518922525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2864 ASHMUN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAULT SAINTE MARIE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-632-5200
Provider Business Mailing Address Fax Number:
906-632-5276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2864 ASHMUN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAULT SAINTE MARIE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-632-5200
Provider Business Practice Location Address Fax Number:
906-632-5276
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CULFA
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH DIRECTOR
Authorized Official Telephone Number:
906-632-5200

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 231838 . This is a "FQHC FACILITY ID" identifier . This identifiers is of the category "OTHER".




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