# DICKINSON COUNTY HEALTHCARE SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265832026
- **Authorized official:** JODI MARTIN (INSURANCE CREDENTIALING SPECIALIST)
- **Authorized official phone:** (906) 776-5705

## Contact information

- **Practice address:** 1721 S STEPHENSON AVE, IRON MOUNTAIN, MI 49801-3637
- **Practice address phone:** (906) 774-1313
- **Practice address fax:** (906) 776-5639
- **Mailing address:** PO BOX 549, IRON MOUNTAIN, MI 49801-0549
- **Mailing address phone:** (906) 774-1313
- **Mailing address fax:** (906) 776-5639

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 4704233146 | MI | Yes |

## Other

- **Enumeration date:** 08/29/2014
- **Last updated:** 08/29/2014