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General NPI Number Information
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NPI Number | 1548630460
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Entity Type | Organization
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Legal Business Name | AUSABLE FREE CLINIC
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Dates
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Enumeration Date | 10/05/2015
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 1200 E NORTH DOWN RIVER RD
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City | GRAYLING
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State | MI
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Zip | 49738-8025
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Country | US
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Telephone | 989-348-0740
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Fax | 989-348-0082
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Provider Business Mailing Address
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Address Line | 1100 E MICHIGAN AVE
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City | GRAYLING
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State | MI
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Zip | 49738-1312
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Country | US
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Telephone | 989-348-0740
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Fax | 989-348-0082
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANDREW BROOKES
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Credential | RN, BSN, CEN
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Telephone | 989-348-0740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 796521
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License Number State | MI
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