Organization
KEWEENAW BAY INDIAN COMMUNITY D.A.LAPOINTE HEALTH FACILITY PHARMACY
Active
Parent organization
KEWEENAW BAY INDIAN COMMUNITY D,A.LAPOINTE HEALTH FACILITY
Organization subpart
Yes
Provider details
NPI number
Legal business name
KEWEENAW BAY INDIAN COMMUNITY D,A.LAPOINTE HEALTH FACILITY
Authorized official
MS. KATHY MAYO (INTERIM HEALTH ADMINISTRATOR)
(906) 353-8700
Entity
Organization
Contact information
Practice address
102 SUPERIOR AVE, BARAGA, MI 49908-9673
(906) 353-4555
(906) 353-8066
Mailing address
102 SUPERIOR AVE, BARAGA, MI 49908-9673
(906) 353-4555
(906) 353-8066
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336232289
—
MI
Enumeration date
04/14/2011
Last updated
12/20/2017
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