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NPI Code Detail

MEDICARE: MATCH-E-BE-NASH-SHE-WISH BAND OF POTTAWATOMI INDIANS

MEDICARE: MATCH-E-BE-NASH-SHE-WISH BAND OF POTTAWATOMI INDIANS
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
1333600000XPharmacy

General Provider Information

NPI Number : 1689232241
Entity Type Code : Organization
Provider Name (Legal Business Name) : MATCH-E-BE-NASH-SHE-WISH BAND OF POTTAWATOMI INDIANS
Provider Business Mailing Address
First Line : 2880 MISSION DR
Second Line :
City : SHELBYVILLE
State : MI
Zip : 49344-9580
Country : US
Telephone Number : 269-397-1760
Fax Number :
Provider Business Practice Location Address
First Line : 2880 MISSION DR
Second Line :
City : SHELBYVILLE
State : MI
Zip : 49344-9580
Country : US
Telephone Number : 269-397-1760
Fax Number :
Authorized Official
Title or Position : HEALTH AND HUMAN SERVICES DIRECTOR
Name : KELLY WESAW
Credential :
Telephone Number : 269-397-1760
Provider Enumeration Date : 05/30/2019
Last Update Date : 05/30/2019

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Directions to “MATCH-E-BE-NASH-SHE-WISH BAND OF POTTAWATOMI INDIANS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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