Basic Information
| Provider Information | |||||||||
| NPI: | 1275079725 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALCONA CITIZENS FOR HEALTH, INC. | ||||||||
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| OtherOrganizationName: | ALCONA HEALTH CENTER PETOSKEY CHILD HEALTH ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 177 N BARLOW RD | ||||||||
| Address2: | |||||||||
| City: | HARRISVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487409607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897368157 | ||||||||
| FaxNumber: | 9893583762 | ||||||||
| Practice Location | |||||||||
| Address1: | 2390 MITCHELL PARK DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497708965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314872250 | ||||||||
| FaxNumber: | 2313487972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2017 | ||||||||
| LastUpdateDate: | 01/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | BAUMGARDER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9897368157 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.