Basic Information
| Provider Information | |||||||||
| NPI: | 1760814651 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DICKINSON COUNTY HEALTHCARE SYSTEM | ||||||||
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| OtherOrganizationName: | DICKINSON GYNECOLOGY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 549 | ||||||||
| Address2: | |||||||||
| City: | IRON MOUNTAIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498010549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9067741313 | ||||||||
| FaxNumber: | 9067765639 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 S HEMLOCK ST | ||||||||
| Address2: | |||||||||
| City: | IRON MOUNTAIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498013805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9067791290 | ||||||||
| FaxNumber: | 9067792154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2013 | ||||||||
| LastUpdateDate: | 08/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | HENDERSON | ||||||||
| AuthorizedOfficialFirstName: | ALICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 9067765665 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPC, CCP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301043588 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.