Healthcare Provider Details

I. General information

NPI: 1831408459
Provider Name (Legal Business Name): DICKINSON COUNTY HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 EAST BLVD
KINGSFORD MI
49802-4436
US

IV. Provider business mailing address

PO BOX 549
IRON MOUNTAIN MI
49801-0549
US

V. Phone/Fax

Practice location:
  • Phone: 906-774-4000
  • Fax: 906-774-0088
Mailing address:
  • Phone: 906-774-1313
  • Fax: 906-776-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALICIA HENDERSON
Title or Position: PHYSICIAN BILLING SUPERVISOR
Credential: CPC, CCP
Phone: 906-776-5665