Basic Information
| Provider Information | |||||||||
| NPI: | 1922464254 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST MICHIGAN HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10767 E TRAVERSE HWY | ||||||||
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| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496846219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319470351 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6051 FRANKFORT HWY | ||||||||
| Address2: | |||||||||
| City: | BENZONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496169558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319471112 | ||||||||
| FaxNumber: | 2319477739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2015 | ||||||||
| LastUpdateDate: | 01/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | BRITTON | ||||||||
| AuthorizedOfficialFirstName: | HEIDI | ||||||||
| AuthorizedOfficialMiddleName: | MAE | ||||||||
| AuthorizedOfficialTitleorPosition: | CHEIF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2319471112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MPH, | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.