Healthcare Provider Details

I. General information

NPI: 1659536035
Provider Name (Legal Business Name): MACKINAC STRAITS HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 N STATE ST
SAINT IGNACE MI
49781-1048
US

IV. Provider business mailing address

1140 N STATE ST
SAINT IGNACE MI
49781-1048
US

V. Phone/Fax

Practice location:
  • Phone: 906-643-8585
  • Fax: 906-643-0373
Mailing address:
  • Phone: 906-643-8585
  • Fax: 906-643-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SONJA SPRAGUE
Title or Position: CREDENTIALING
Credential:
Phone: 906-643-0451