Basic Information
| Provider Information | |||||||||
| NPI: | 1124480108 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST MICHIGAN HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10767 E TRAVERSE HWY | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496846219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319471112 | ||||||||
| FaxNumber: | 2319477739 | ||||||||
| Practice Location | |||||||||
| Address1: | 6433 8 MILE RD | ||||||||
| Address2: | |||||||||
| City: | BEAR LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496149797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318897180 | ||||||||
| FaxNumber: | 2318897181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2016 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | BRITTON | ||||||||
| AuthorizedOfficialFirstName: | HEIDI | ||||||||
| AuthorizedOfficialMiddleName: | MAE | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2319471112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPH, CPHA | ||||||||
| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.