Healthcare Provider Details

I. General information

NPI: 1669865838
Provider Name (Legal Business Name): EAST JORDAN FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 S M 88 HWY
BELLAIRE MI
49615-9082
US

IV. Provider business mailing address

601 BRIDGE ST
EAST JORDAN MI
49727-9383
US

V. Phone/Fax

Practice location:
  • Phone: 231-533-6655
  • Fax: 231-533-5331
Mailing address:
  • Phone: 231-536-2206
  • Fax: 231-536-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010666
License Number StateMI

VIII. Authorized Official

Name: DANIEL MCKINNON
Title or Position: CEO
Credential:
Phone: 231-536-2206