Healthcare Provider Details

I. General information

NPI: 1801214218
Provider Name (Legal Business Name): UPPER GREAT LAKES FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 10TH AVE
MENOMINEE MI
49858-3058
US

IV. Provider business mailing address

301 EXPLORER ST
GWINN MI
49841-2813
US

V. Phone/Fax

Practice location:
  • Phone: 906-290-5000
  • Fax: 906-863-2408
Mailing address:
  • Phone: 906-290-5000
  • Fax: 906-372-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateMI

VIII. Authorized Official

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