MEDICARE: VILLAGE OF MACKINAW CITY

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	261QE0002X	Emergency Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0A60005	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1841380052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF MACKINAW CITY

Provider Business Mailing Address
First Line	:	PO BOX 580
Second Line	:	102 S HURON AVE
City	:	MACKINAW CITY
State	:	MI
Zip	:	49701
Country	:	US
Telephone Number	:	231-436-5351
Fax Number	:	231-436-4166

Provider Business Practice Location Address
First Line	:	102 S. HURON
Second Line	:
City	:	MACKINAW CITY
State	:	MI
Zip	:	49701
Country	:	US
Telephone Number	:	231-436-5351
Fax Number	:

Authorized Official
Title or Position	:	VILLAGE TREASURER
Name	:	MRS. PATRICIA B PEPPLER
Credential	:
Telephone Number	:	231-436-5351

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	02/15/2008

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Directions to “VILLAGE OF MACKINAW CITY ” Practice Location

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