Organization
KEWEENAW BAY INDIAN COMMUNITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL BRUCE MILLS CCS-P (MEDICAL BILLING CLERK)
(906) 353-4542
Entity
Organization
Contact information
Practice address
102 SUPERIOR AVE, BARAGA, MI 49908-9673
(906) 353-4542
(906) 353-8799
Mailing address
102 SUPERIOR AVE, BARAGA, MI 49908-9673
(906) 353-4542
(906) 353-8799
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
231845
MI
Other
Enumeration date
10/02/2006
Last updated
10/28/2010
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