Basic Information
| Provider Information | |||||||||
| NPI: | 1588727671 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MACKINAC STRAITS HOSPITAL & HEALTH CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MACKINAC ISLAND MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 BURDETTE ST | ||||||||
| Address2: | |||||||||
| City: | SAINT IGNACE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497811712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9066438585 | ||||||||
| FaxNumber: | 9066430373 | ||||||||
| Practice Location | |||||||||
| Address1: | MARKET ST. | ||||||||
| Address2: | |||||||||
| City: | MACKINAC ISLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497570536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9068473582 | ||||||||
| FaxNumber: | 9068476490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9066430455 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 700D96239 | 01 | MI | BLUE CROSS BSM GROUP | OTHER |