Healthcare Provider Details

I. General information

NPI: 1750159158
Provider Name (Legal Business Name): ALCONA CITIZENS FOR HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 US HIGHWAY 23 NORTH
ALPENA MI
49707
US

IV. Provider business mailing address

PO BOX 655
ALPENA MI
49707-0655
US

V. Phone/Fax

Practice location:
  • Phone: 989-358-3475
  • Fax: 989-358-3775
Mailing address:
  • Phone: 989-736-9815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: NANCY SPENCER
Title or Position: CEO
Credential:
Phone: 989-358-3916