Healthcare Provider Details

I. General information

NPI: 1700103777
Provider Name (Legal Business Name): UPPER GREAT LAKES FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 EXPLORER STREET
GWINN MI
49841-2813
US

IV. Provider business mailing address

135 E M35
GWINN MI
49841-9160
US

V. Phone/Fax

Practice location:
  • Phone: 906-346-4924
  • Fax: 906-372-3230
Mailing address:
  • Phone: 906-346-4924
  • Fax: 906-372-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. TREVOR HODGES
Title or Position: CEO
Credential:
Phone: 906-483-1846