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General NPI Number Information
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NPI Number | 1669680187
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Entity Type | Organization
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Legal Business Name | EAST JORDAN FAMILY HEALTH CENTER
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 7960 W. OLD STATE ROAD
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City | CENTRAL LAKE
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State | MI
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Zip | 49622
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Country | US
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Telephone | 231-544-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 7960 W OLD STATE RD
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City | CENTRAL LAKE
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State | MI
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Zip | 49622-5149
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Country | US
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Telephone | 231-544-3700
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DANIEL MCKINNON
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Credential |
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Telephone | 231-536-2206
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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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