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
1	207RC0000X	Cardiovascular Disease Physician
2	208800000X	Urology Physician
3	207V00000X	Obstetrics & Gynecology Physician
4	363A00000X	Physician Assistant
5	363L00000X	Nurse Practitioner
6	207N00000X	Dermatology Physician
7	207X00000X	Orthopaedic Surgery Physician
8	213E00000X	Podiatrist
9	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1821345646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DICKINSON COUNTY HEALTHCARE SYSTEM

Provider Business Mailing Address
First Line	:	PO BOX 549
Second Line	:
City	:	IRON MOUNTAIN
State	:	MI
Zip	:	49801-0549
Country	:	US
Telephone Number	:	906-774-1313
Fax Number	:	906-776-5639

Provider Business Practice Location Address
First Line	:	2001 MINNEAPOLIS AVE
Second Line	:	SUITE E
City	:	GLADSTONE
State	:	MI
Zip	:	49837-2060
Country	:	US
Telephone Number	:	906-428-2000
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN BILLING SUPERVISOR
Name	:	ALICIA HENDERSON
Credential	:
Telephone Number	:	906-776-5665

Provider Enumeration Date	:	08/10/2012
Last Update Date	:	08/24/2012

Similar Medicare Providers

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Practice Location Address:

2001 MINNEAPOLIS AVE , SUITE D
GLADSTONE, MI
49837-2060

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Practice Location Address:

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1972092831 — BELLIN HEALTH IRON MOUNTAIN INC
Practice Location Address:

2001 MINNEAPOLIS AVE STE D
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1487148219 — BREANNA MARIE WINLING PTA
Practice Location Address:

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1518588284 — IRON MOUNTAIN VAMC
Practice Location Address:

2001 MINNEAPOLIS AVE
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Directions to “DICKINSON COUNTY HEALTHCARE SYSTEM ” Practice Location

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