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General NPI Number Information
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NPI Number | 1235540501
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Entity Type | Organization
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Legal Business Name | STEHOUWER FREE CLINIC
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Dates
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Enumeration Date | 05/08/2014
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Last Update Date | 05/08/2014
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Provider Practice Location Address
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Address Line | 201 N MITCHELL ST L-1
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City | CADILLAC
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State | MI
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Zip | 49601-1859
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Country | US
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Telephone | 231-876-6152
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Fax | 231-779-9829
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Provider Business Mailing Address
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Address Line | 201 N MITCHELL ST L-1
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City | CADILLAC
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State | MI
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Zip | 49601-1859
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Country | US
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Telephone | 231-876-6152
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Fax | 231-779-9829
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MICHELLE PAYNE
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Credential |
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Telephone | 231-876-6152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 23D0996622
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License Number State | MI
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