MEDICARE: DICKINSON COUNTY HEALTHCARE SYSTEM

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	261QR0200X	Radiology Clinic/Center	220020	MI

General Provider Information

NPI Number	:	1508162561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DICKINSON COUNTY HEALTHCARE SYSTEM

Provider Business Mailing Address
First Line	:	2001 MINNEAPOLIS AVE
Second Line	:	SUITE D
City	:	GLADSTONE
State	:	MI
Zip	:	49837-2060
Country	:	US
Telephone Number	:	906-776-5640
Fax Number	:	906-776-5639

Provider Business Practice Location Address
First Line	:	2001 MINNEAPOLIS AVE
Second Line	:	SUITE D
City	:	GLADSTONE
State	:	MI
Zip	:	49837-2060
Country	:	US
Telephone Number	:	906-776-5640
Fax Number	:	906-776-5639

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. JOHN SCHON
Credential	:
Telephone Number	:	906-774-1313

Provider Enumeration Date	:	02/08/2011
Last Update Date	:	03/22/2011

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