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NPI Code Detail

MEDICARE: HIAWATHA COMMUNITY MENTAL HEALTH AUTHORITY

MEDICARE: HIAWATHA COMMUNITY MENTAL HEALTH AUTHORITY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17509104110OTHERMIBCBS
27509104130OTHERMIBCBS
37509104120OTHERMIBCBS

General Provider Information

NPI Number : 1457529505
Entity Type Code : Organization
Provider Name (Legal Business Name) : HIAWATHA COMMUNITY MENTAL HEALTH AUTHORITY
Provider Business Mailing Address
First Line : 125 N LAKE ST
Second Line :
City : MANISTIQUE
State : MI
Zip : 49854-1234
Country : US
Telephone Number : 906-341-2144
Fax Number : 906-341-5793
Provider Business Practice Location Address
First Line : 114 W ELLIOTT ST
Second Line :
City : SAINT IGNACE
State : MI
Zip : 49781-1868
Country : US
Telephone Number : 906-643-8616
Fax Number : 906-643-7194
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. SAMUEL HARMA
Credential :
Telephone Number : 906-341-2144
Provider Enumeration Date : 02/12/2008
Last Update Date : 02/12/2008

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Practice Location Address:
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1922267210 — MICHAEL WISE
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1134458029 — MRS. DEBRA THURMAN DOBBS LPC
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Practice Fax:
1730469008 — MARK HALVORSEN
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1922490176 — MS. LINDSEY JO CRONIN LLPC
Practice Location Address:
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Directions to “HIAWATHA COMMUNITY MENTAL HEALTH AUTHORITY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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