INTERCARE COMMUNITY HEATH NETWORK MEDICAL VAN (NPI# 1114335767) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114335767 |
| Entity Type | Organization |
| Organization Name | INTERCARE COMMUNITY HEATH NETWORK MEDICAL VAN |
| Practice Address |
308 Charles Street Bangor MI 49013-1246 |
| Mailing Address |
50 Industrial Park Drive Bangor MI 49013-1246 |
| Practice Telephone | 2694277937 |
| Practice Fax Number | 2694275180 |
| Mailing Telephone | 2694277937 |
| Mailing Fax Number | 2694275180 |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2014-07-28 |
| Authorized Official Name | VELMA HENDERSHOTT (CEO/PRESIDENT) |
| Authorized Official Telephone | 2694277937 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Street Address |
308 CHARLES STREET |
| City | BANGOR |
| State | MI |
| Zip Code | 49013-1246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962439950 | Michele E Allen | Dentist | 308 Charles Street, Bangor, MI 49013 | 2006-06-27 |
| 1417319476 | Terri Lynn Harbin Ilg | Dental Hygienist | 308 Charles Street, Intercare Community Health Network, Bangor, MI 49013 | 2016-03-28 |
| 1518375740 | Carolyn Thon | Dental Hygienist | 308 Charles Street, Bangor, MI 49013-1246 | 2014-07-31 |
| 1194133744 | Intercare Community Health Network Dental Van | Clinic/Center | 308 Charles Street, Bangor, MI 49013-1246 | 2014-07-28 |
| 1356540926 | Brandy L Zantello | Dental Hygienist | 308 Charles Street, Bangor, MI 49013 | 2007-07-13 |
| 1538365705 | Alicia Scuiletti | Dental Hygienist | 308 Charles Street, Bangor, MI 49013 | 2007-06-25 |
| 1730197310 | Joette Marie Wyman | Dental Hygienist | 308 Charles Street, Bangor, MI 49013 | 2006-08-03 |
| 1366473811 | William L Wilkinson | Family Medicine | 308 Charles Street, Bangor, MI 49013 | 2006-07-05 |
| 1619908167 | Nancy Anne Virgilio | Physician Assistant | 308 Charles Street, Bangor, MI 49013 | 2006-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083237051 | Twin Doves I LLC | Community Based Residential Treatment Facility, Mental Illness | 48617 36th Ave., Bangor, MI 49013 | 2020-05-25 |
| 1629252895 | Van Buren Cass District Health Department | Community/Behavioral Health | 803 West Arlington, Bangor Health Center, Bangor, MI 49013 | 2007-12-24 |
| 1245426808 | Karen Lee Replogle | Registered Nurse | 52101 34th Avenue, Bangor, MI 49013 | 2007-09-18 |
| 1518152560 | Virginia Douglas | Registered Nurse | 52101 34 Avenue, Bangor, MI 49013 | 2007-09-12 |
| 1992818835 | Intercare Community Health Network | Clinic/Center | 308 Charles St, Bangor, MI 49013 | 2006-08-16 |
| 1326058512 | Intercare Community Health Network | Clinic/Center | 50 Industrial Park Dr, Bangor, MI 49013 | 2006-08-09 |
| 1366051898 | Kasie M Broe | Social Worker | 52101 34th Avenue, Bangor, MI 49013 | 2020-07-30 |
| 1255985966 | Audria Gilliland | Registered Nurse | 52101 34th Avenue, Bangor, MI 49013 | 2019-07-31 |
| 1891185765 | Teresa Ansinn | Nurse Practitioner | 50 Industrial Park Rd, Bangor, MI 49013 | 2015-01-30 |
| 1093985087 | Nancy Lou Grib | Registered Nurse | 52101 34 Avenue, Bangor, MI 49013 | 2008-03-05 |
| Find all providers in zip 49013 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760973960 | Penobscot Community Health Center | Clinic/Center | 1012 Union St Ste 3, Bangor, ME 04401-3058 | 2018-05-23 |
| 1174845697 | Penobscot Community Health Center | Clinic/Center | 181 Corporate Drive, Bangor, ME 04401 | 2010-02-25 |
| 1992818835 | Intercare Community Health Network | Clinic/Center | 308 Charles St, Bangor, MI 49013 | 2006-08-16 |
| 1326058512 | Intercare Community Health Network | Clinic/Center | 50 Industrial Park Dr, Bangor, MI 49013 | 2006-08-09 |
| 1194133744 | Intercare Community Health Network Dental Van | Clinic/Center | 308 Charles Street, Bangor, MI 49013-1246 | 2014-07-28 |
| 1639419468 | Penobscot Community Health Center | Clinic/Center | 1012 Union St, Suite 3, Bangor, ME 04401-3060 | 2013-02-14 |
| 1285685628 | Penobscot Community Health Center | Clinic/Center | 6 Telcom Dr, Bangor, ME 04401-3072 | 2006-05-12 |
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| 1831706993 | Family Medical Center of Michigan, Inc | Clinic/Center | 503 Washington St Rm 150, Monroe, MI 48161-1309 | 2020-09-23 |
| 1326654666 | Family Medical Center of Michigan,inc | Clinic/Center | 550 E Main St Ste 1001, Hudson, MI 49247-9535 | 2020-09-22 |
| 1922613975 | Hackley Community Care Center Inc | Clinic/Center | 6245 Syers Rd Ste A, Holton, MI 49425-7557 | 2020-09-15 |
| 1700400389 | Northwest Michigan Health Services, Inc. | Clinic/Center | 300 W Broadway Ave Trlr 1, Scottville, MI 49454-1019 | 2020-05-30 |
| 1679195721 | Family Medical Center of Michigan,inc | Clinic/Center | 2740 Collingwood St Ste 100, Detroit, MI 48206-1473 | 2020-05-12 |
| 1235750571 | Great Lakes Bay Health Centers | Clinic/Center | 2300 Veterans Memorial Pkwy, Saginaw, MI 48601-1268 | 2020-04-28 |
| 1053948265 | Upper Great Lakes Family Health Center | Clinic/Center | 1414 W Fair Ave Ste 242, Marquette, MI 49855-5406 | 2020-03-26 |
| 1568096923 | Grace Health, Inc. | Clinic/Center | 825 Capital Ave Ne, Battle Creek, MI 49017-5605 | 2020-02-25 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.