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General NPI Number Information
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NPI Number | 1851358873
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Entity Type | Organization
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Legal Business Name | BAY MILLS INDIAN COMMUNITY
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 12455 W LAKESHORE DR
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City | BRIMLEY
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State | MI
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Zip | 49715-9327
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Country | US
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Telephone | 906-248-5527
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Fax | 906-248-5765
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Provider Business Mailing Address
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Address Line | 12455 W LAKESHORE DR
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City | BRIMLEY
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State | MI
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Zip | 49715-9327
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Country | US
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Telephone | 906-248-5527
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Fax | 906-248-2572
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Authorized Official
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Title or Position | CLINIC COORDINATOR
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Name | ABBY KAUNISTO
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Credential |
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Telephone | 906-248-8315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | OA76020
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License Number State | MI
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