Healthcare Provider Details

I. General information

NPI: 1841380052
Provider Name (Legal Business Name): VILLAGE OF MACKINAW CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S. HURON
MACKINAW CITY MI
49701
US

IV. Provider business mailing address

PO BOX 580 102 S HURON AVE
MACKINAW CITY MI
49701
US

V. Phone/Fax

Practice location:
  • Phone: 231-436-5351
  • Fax:
Mailing address:
  • Phone: 231-436-5351
  • Fax: 231-436-4166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICIA B PEPPLER
Title or Position: VILLAGE TREASURER
Credential:
Phone: 231-436-5351