Healthcare Provider Details

I. General information

NPI: 1417886193
Provider Name (Legal Business Name): UPPER GREAT LAKES FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

IV. Provider business mailing address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1901
  • Fax: 906-483-1909
Mailing address:
  • Phone: 906-483-1901
  • Fax: 906-483-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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