Healthcare Provider Details

I. General information

NPI: 1538597778
Provider Name (Legal Business Name): DICKINSON COUNTY HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2013
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 HAMILTON AVE
KINGSFORD MI
49802-4513
US

IV. Provider business mailing address

PO BOX 549
IRON MOUNTAIN MI
49801-0549
US

V. Phone/Fax

Practice location:
  • Phone: 906-776-5800
  • Fax: 906-228-0200
Mailing address:
  • Phone: 906-774-1313
  • Fax: 906-776-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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