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General NPI Number Information
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NPI Number | 1417411760
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Entity Type | Organization
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Legal Business Name | DICKINSON COUNTY HEALTHCARE SYSTEM
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 1711 S STEPHENSON AVE STE 205
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-3649
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Country | US
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Telephone | 906-774-1313
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 549
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-0549
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN BILLING SUPERVISOR
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Name | ALICIA R HENDERSON
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Credential |
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Telephone | 906-774-1313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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