MEDICARE: GREAT LAKES BAY HEALTH CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1093570293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES BAY HEALTH CENTERS

Provider Business Mailing Address
First Line	:	501 LAPEER AVE
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48607-1203
Country	:	US
Telephone Number	:	989-759-6464
Fax Number	:	989-399-8233

Provider Business Practice Location Address
First Line	:	1624 COLUMBUS AVE
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-6827
Country	:	US
Telephone Number	:	989-759-6464
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	LISA GALONSKA
Credential	:
Telephone Number	:	989-759-6464

Provider Enumeration Date	:	02/16/2024
Last Update Date	:	02/21/2024

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Directions to “GREAT LAKES BAY HEALTH CENTERS ” Practice Location

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