Healthcare Provider Details

I. General information

NPI: 1225252422
Provider Name (Legal Business Name): ALCONA CITIZENS FOR HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N STATE ST SUITE A
HARRISVILLE MI
48740-9255
US

IV. Provider business mailing address

PO BOX 655
ALPENA MI
49707
US

V. Phone/Fax

Practice location:
  • Phone: 989-724-5655
  • Fax: 989-358-3730
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY SPENCER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 989-358-0673