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General NPI Number Information
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NPI Number | 1912998287
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Entity Type | Organization
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Legal Business Name | MIDMICHIGAN HEALTH SERVICES
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 9249 W LAKE CITY RD
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City | HOUGHTON LAKE
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State | MI
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Zip | 48629-9602
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Country | US
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Telephone | 989-422-5122
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Fax | 989-422-6838
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Provider Business Mailing Address
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Address Line | 9249 W LAKE CITY RD
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City | HOUGHTON LAKE
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State | MI
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Zip | 48629-9602
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Country | US
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Telephone | 989-422-5122
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Fax | 989-422-4378
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JAMES P. RASCHKE
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Credential |
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Telephone | 989-422-5122
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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 | 4301068191
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License Number State | MI
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