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General NPI Number Information
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NPI Number | 1831390426
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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 | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3500 LUDINGTON ST SUITE 210
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City | ESCANABA
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State | MI
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Zip | 49829-4216
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Country | US
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Telephone | 906-786-9211
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Fax | 906-786-3338
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Provider Business Mailing Address
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Address Line | 3500 LUDINGTON ST SUITE 210
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City | ESCANABA
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State | MI
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Zip | 49829-4216
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Country | US
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Telephone | 906-786-9211
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Fax | 906-786-3338
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Authorized Official
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Title or Position | HEALTH DIVISION DIRECTOR
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Name | BONNIE L CULFA
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Credential | RN, MSN
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Telephone | 906-632-5275
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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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