GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS (NPI# 1134281132) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134281132 |
| Entity Type | Organization |
| Organization Name | GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS |
| Other Organization Name | GRAND TRAVERSE BAND FAMILY HEALTH CLINIC |
| Practice Address |
2300 N Stallman Rd Suttons Bay MI 49682-9158 |
| Practice Telephone | 2315347200 |
| Practice Fax Number | 2315347460 |
| Mailing Telephone | 2315347200 |
| Mailing Fax Number | 2315347460 |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2019-03-15 |
| Authorized Official Name | LOI E CHAMBERS (BILLING MANAGER) |
| Authorized Official Telephone | 2315347477 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1376553586 | 05 | |
| MI | BCBS | 700D545020 | 01 |
| Other Name | Type Code |
|---|---|
| Grand Traverse Band Family Health Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508126517 | Grand Traverse Band of Ottawa and Chippewa Indians | Clinic/Center | 2300 N Stallman Road, Peshawbestown, MI 49682 | 2012-05-23 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS | 2605 N West Bay Shore Dr, Peshawbestown, MI 49682-9275 |
| Street Address |
2300 N STALLMAN RD |
| City | SUTTONS BAY |
| State | MI |
| Zip Code | 49682-9158 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558913251 | Baybrooke Counseling | General Practice | 421 St. Josephs Ave, Suttons Bay, MI 49682 | 2019-07-12 |
| 1942756259 | Aleeah Bebermeyer | Physical Therapy Assistant | 73 W Fourth St., Sutton Bay, MI 49682 | 2016-08-28 |
| 1619346780 | Kathy Ann Bowers | Registered Nurse | 2300 N. Stallman Rd, Suttons Bay, MI 49682 | 2015-09-18 |
| 1508126517 | Grand Traverse Band of Ottawa and Chippewa Indians | Clinic/Center | 2300 N Stallman Road, Peshawbestown, MI 49682 | 2012-05-23 |
| 1063648491 | John Allen Nagel | Pharmacist | 321 N.st.joseph, Suttons Bay, MI 49682 | 2009-05-29 |
| 1205953395 | Mark Hall Hoffman | Chiropractor | 111 Madison St, Suttons Bay, MI 49682 | 2007-03-23 |
| 1104957109 | Lise C. Zahn | Physical Therapist | 73 Fourth St., Suttons Bay, MI 49682 | 2007-03-08 |
| 1457481251 | Andrea Darlene Xaver | Pharmacist | 321 N. St. Joseph St., Suttons Bay, MI 49682 | 2007-03-07 |
| 1871643858 | Steven David Hall | Dentist | 1299 Southwest Bay Shore Drive, Suttons Bay, MI 49682 | 2007-01-11 |
| 1457441362 | Donald R Mileski | Pharmacist | 321 N Saint Joseph St, Suttons Bay, MI 49682 | 2006-10-13 |
| Find all providers in zip 49682 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 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 | ||||
| City | SUTTONS BAY |
| Zip Code | 49682 |
Please comment or provide details below to improve the information on GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS.
| 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.