UPPER GREAT LAKES FAMILY HEALTH CENTER (NPI# 1508289273) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1508289273 |
Entity Type | Organization |
Organization Name | UPPER GREAT LAKES FAMILY HEALTH CENTER |
Other Organization Name | ICE LAKE FAMILY HEALTH CENTER |
Practice Address |
1500 W Ice Lake Road Iron River MI 49935-8509 |
Mailing Address |
506 Campus Drive Hancock MI 49930-1569 |
Practice Telephone | 9062655378 |
Practice Fax Number | 9062654245 |
Mailing Telephone | 9064831705 |
Mailing Fax Number | 9064831394 |
Enumeration Date | 2014-01-30 |
Last Update Date | 2016-04-18 |
Authorized Official Name | DONALD A SIMILA (CEO) |
Authorized Official Telephone | 9064831325 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities | ||
Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
MI | Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
Ice Lake Family Health Center | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1053948265 | Upper Great Lakes Family Health Center | Clinic/Center | 1414 W Fair Ave Ste 242, Marquette, MI 49855-5406 | 2020-03-26 |
1659889673 | Upper Great Lakes Family Health Center | Psychiatry & Neurology | 965 Fee Rd Rm A229, East Lansing, MI 48824-6410 | 2018-01-11 |
1336563832 | Upper Great Lakes Family Health Center | Clinic/Center | 751 S 7th Street, Ontonagon, MI 49953-1450 | 2014-02-05 |
1740603885 | Upper Great Lakes Family Health Center | Clinic/Center | 945 Ninth Street, Lake Linden, MI 49945-1100 | 2014-01-25 |
1811325103 | Upper Great Lakes Family Health Center | Clinic/Center | 600 Macinnes Drive, Houghton, MI 49931-1144 | 2013-10-23 |
1700103777 | Upper Great Lakes Family Health Center | Family Medicine | 301 Explorer Street, Gwinn, MI 49841-2813 | 2010-04-29 |
1104158690 | Upper Great Lakes Family Health Center | Family Medicine | 135 East M 35, Gwinn, MI 49841-9159 | 2010-02-08 |
1396295721 | Upper Great Lakes Family Health Center | Dentist | 56720 Calumet Ave, Calumet, MI 49913-1967 | 2016-10-10 |
1164893491 | Upper Great Lakes Family Health Center | Dentist | 301 Explorer St, Gwinn, MI 49841-2813 | 2015-10-13 |
1205217239 | Upper Great Lakes Family Health Center | Dentist | 1550 W Quincy St, Hancock, MI 49930-1223 | 2015-06-16 |
Entity Type | Entity Name | Entity Address |
---|---|---|
System for Award Management (SAM) Entities | UPPER GREAT LAKES FAMILY HEALTH CENTER | 506 Campus Dr, Hancock, MI 49930-1569 |
Street Address |
1500 W ICE LAKE ROAD |
City | IRON RIVER |
State | MI |
Zip Code | 49935-8509 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1457865198 | Aspirus Iron River Hospital & Clinics, Inc. | Clinic/Center | 814 South Ice Lake Road, Iron River, MI 49935 | 2017-11-16 |
1659807808 | Shannon Koski | Specialist/Technologist | 1800 N Verona Ave, Iron River, MI 49935 | 2017-05-10 |
1912166166 | Rk Atanasoff Od PC | Optometrist | 131 W Genesee St, Iron River, MI 49935 | 2008-06-03 |
1215102272 | Aspirus Iron River Hospital & Clinics, Inc. | Pathology | 1400 West Ice Lake Road, Iron River, MI 49935 | 2008-04-29 |
1164620555 | Mary Jo Rohde | Social Worker | 1201 Stambough Ave, Iron River, MI 49935 | 2007-07-06 |
1861693848 | Michael Wallace Varney | Psychologist | 217 North 10th Avenue, Iron River, MI 49935 | 2007-05-29 |
1962616623 | Advanced Care Smile Center Inc | Dentist | 528 N 1st Avenue, Iron River, MI 49935 | 2007-05-10 |
1376551788 | Raymond Krist Atanasoff | Optometrist | 131 W Genesee Street, Iron River, MI 49935 | 2006-08-03 |
1205873510 | Raymond J Meyers | Nurse Anesthetist, Certified Registered | 1400 Ice Lake Rd., Iron River, MI 49935 | 2006-06-02 |
1497750830 | Aspirus Iron River Hospital & Clinics, Inc. | General Acute Care Hospital | 1400 W Ice Lake Rd, Iron River, MI 49935 | 2005-06-14 |
Find all providers in zip 49935 |
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 |
---|---|---|---|---|
1811178825 | The Lakes Community Health Center, Inc | Clinic/Center | 7665 Us Hwy 2, Iron River, WI 54847-4690 | 2007-11-19 |
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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 | IRON RIVER |
Zip Code | 49935 |
Please comment or provide details below to improve the information on UPPER GREAT LAKES FAMILY HEALTH CENTER.
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.