Healthcare Provider Details

I. General information

NPI: 1487164257
Provider Name (Legal Business Name): ALCONA CITIZENS FOR HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 E RIVER RD
OSCODA MI
48750-9026
US

IV. Provider business mailing address

PO BOX 655
ALPENA MI
49707-0655
US

V. Phone/Fax

Practice location:
  • Phone: 989-739-2033
  • Fax:
Mailing address:
  • Phone: 989-736-9815
  • 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 Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: NANCY SPENCER
Title or Position: CEO
Credential:
Phone: 989-358-0673