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GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS NPI 1134281132


NPI Information

NPI: 1134281132
Provider Name: GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS

Doing Business As: GRAND TRAVERSE BAND FAMILY HEALTH CLINIC

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 23D0962470

Address:
2300 N STALLMAN RD
SUTTONS BAY, MI
ZIP 49682
Phone: (231) 534-7200
Get Directions

GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS is a federally qualified health center (fqhc) clinic center in Suttons Bay, MI. GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS NPI is 1134281132. The provider is registered as an organization entity type.
The provider Is Doing Business As Grand Traverse Band Family Health Clinic.

The provider's business location address is:

2300 N STALLMAN RD
SUTTONS BAY, MI
ZIP 49682-158
Phone: (231) 534-7200
Fax: (231) 534-7460

The provider's authorized official is Loi E Chambers .
The authorized official title is Billing Manager and has the following contact phone number (231) 534-7477.

The CLIA number assigned to this NPI record is 23D0962470 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 12/15/2006 and was last updated on 3/15/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11376553586MEDICAIDMICHIGAN
2700D545020OTHERMICHIGANBCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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