Healthcare Provider Details

I. General information

NPI: 1326005273
Provider Name (Legal Business Name): BAY MILLS INDIAN COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 S PINE VILLAGE RD
BRIMLEY MI
49715-9324
US

IV. Provider business mailing address

12455 W LAKESHORE DR
BRIMLEY MI
49715-9327
US

V. Phone/Fax

Practice location:
  • Phone: 906-248-2021
  • Fax: 906-248-2023
Mailing address:
  • Phone: 906-248-5527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number4704182384
License Number StateMI

VIII. Authorized Official

Name: AUDREY BREAKIE
Title or Position: HHS DIRECTOR
Credential:
Phone: 906-248-8327