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NPI Code Detail

MEDICARE: UPPER GREAT LAKES FAMILY HEALTH CENTER

MEDICARE: UPPER GREAT LAKES FAMILY HEALTH CENTER
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
1261QF0400XFederally Qualified Health Center (FQHC)
2261QF0400XFederally Qualified Health Center (FQHC)MI

General Provider Information

NPI Number : 1508289273
Entity Type Code : Organization
Provider Name (Legal Business Name) : UPPER GREAT LAKES FAMILY HEALTH CENTER
Provider Business Mailing Address
First Line : 135 E M35
Second Line :
City : GWINN
State : MI
Zip : 49841-9160
Country : US
Telephone Number : 906-265-5378
Fax Number : 906-372-3230
Provider Business Practice Location Address
First Line : 1500 W ICE LAKE ROAD
Second Line :
City : IRON RIVER
State : MI
Zip : 49935-8509
Country : US
Telephone Number : 906-265-5378
Fax Number : 906-372-3230
Authorized Official
Title or Position : CEO
Name : TREVOR HODGES
Credential :
Telephone Number : 906-483-1846
Provider Enumeration Date : 01/30/2014
Last Update Date : 05/13/2026

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Practice Location Address:
1500 W ICE LAKE RD
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49935-8509
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Practice Fax: 906-372-3230
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1700847977 — MARQUETTE GENERAL HOSPITAL, INC.
Practice Location Address:
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1770699167 — DR. NASSEEM FARHAN RIZKALLA MD
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1124241666 — DR. MICHAEL HARRISON YARD D.O.
Practice Location Address:
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Practice Fax: 906-265-6332

Directions to “UPPER GREAT LAKES FAMILY HEALTH CENTER ” Practice Location

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