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General NPI Number Information
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NPI Number | 1093470312
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Entity Type | Organization
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Legal Business Name | LUCE-MACKINAC DISTRICT HEALTH DEPARTMENT
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 14150 HAMILTON LAKE ROAD
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City | NEWBERRY
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State | MI
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Zip | 49868
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Country | US
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Telephone | 906-293-5107
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Fax |
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Provider Business Mailing Address
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Address Line | 14150 HAMILTON LAKE ROAD
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City | NEWBERRY
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State | MI
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Zip | 49868
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Country | US
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Telephone | 906-293-5107
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | SHAUNTA BOSANIC
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Credential |
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Telephone | 906-341-6951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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