Basic Information
| Provider Information | |||||||||
| NPI: | 1629360797 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MACKINAC STRAITS HEALTH SYSTEM INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PICKFORD MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | SAINT IGNACE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497811048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9066438585 | ||||||||
| FaxNumber: | 9066430373 | ||||||||
| Practice Location | |||||||||
| Address1: | 7742 N M 129 | ||||||||
| Address2: | |||||||||
| City: | PICKFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497749003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9066472217 | ||||||||
| FaxNumber: | 9066472228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2011 | ||||||||
| LastUpdateDate: | 12/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9066430466 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.