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General NPI Number Information
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NPI Number | 1396935045
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Entity Type | Organization
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Legal Business Name | SAULT TRIBE OF CHIPPEWA INDIANS
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 4935 ZEE BA TIK LN
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City | NEWBERRY
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State | MI
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Zip | 49868-8188
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Country | US
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Telephone | 906-293-8181
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Fax | 906-293-3001
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Provider Business Mailing Address
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Address Line | 4935 ZEE BA TIK LN
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City | NEWBERRY
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State | MI
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Zip | 49868-8188
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Country | US
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Telephone | 906-293-8181
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Fax | 906-293-3001
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Authorized Official
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Title or Position | DIVISION OF HEALTH DIRECTOR
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Name | BONNIE CULFA
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Credential | RN MSN
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Telephone | 906-632-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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