Healthcare Provider Details

I. General information

NPI: 1962775080
Provider Name (Legal Business Name): ALCONA CITIZENS FOR HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEMLOCK ST
TAWAS CITY MI
48763-9237
US

IV. Provider business mailing address

PO BOX 279
LINCOLN MI
48742-0279
US

V. Phone/Fax

Practice location:
  • Phone: 989-736-8157
  • Fax:
Mailing address:
  • Phone: 989-736-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE M BAUMGARDNER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 989-736-3020