NPIMap

Organization Active NPI

Upper Great Lakes Family Health Center

Doing business as Upper Great Lakes Family Health Mobile Unit 1

  • Federally Qualified Health Center (FQHC)
  • Laurium, MI
National Provider Identifier
1114788619
Registry record updated May 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Doing business as
Upper Great Lakes Family Health Mobile Unit 1
Practice address
730 Lake Linden Ave
Laurium, MI 49913-2614
Phone
(906) 483-1177
Fax
(906) 372-3230
NPI assigned
Jan 22, 2024
Last updated
May 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Trevor Hodges
Title
Ceo
Phone
(906) 483-1846

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

730 Lake Linden Ave
Laurium, MI 49913-2614

Mailing address

135 E M35
Gwinn, MI 49841-9160
Phone (906) 483-1177

Other names 1

  • Upper Great Lakes Family Health Mobile Unit 1 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240416000318 MI Part A Provider - Federally Qualified Health Center (FQHC) 1951432384 Practice locations: Calumet, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114788619. Details of each certification follow.

Federally qualified health center certification: CCN C71020

Legal name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Doing business as
UPPER GREAT LAKES FAMILY HEALTH MOBILE UNIT I
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 11, 2024
Last certification
Apr 11, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 22, 2024 in MI
Enrollment address
730 Lake Linden Ave
Calumet, MI 49913-2614

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Upper Great Lakes Center18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

56901 S 6th St
Ste 12
Calumet, MI 49913
Phone (906) 483-1177

301 Explorer St
Gwinn, MI 49841
Phone (906) 346-4924

945 9th St
Lake Linden, MI 49945
Phone (906) 483-1000

730 Lake Linden Ave
Laurium, MI 49913
Phone (906) 481-8571

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tanya Johnson Individual Corporate OfficerBoard Member Oct 28, 2020
Trevor Hodges Individual Corporate DirectorCfo Jan 1, 2020
W-2 Managing EmployeeCfo Jan 1, 2020
Mark Rouleau Individual Corporate OfficerBoard Member Nov 24, 2021
Stephen Vairo Individual Corporate OfficerBoard Member Oct 7, 2009
Donald Simila Individual Corporate DirectorCfo Dec 10, 2010
W-2 Managing EmployeeCeo Dec 10, 2010
Kevin L Piggott Individual Corporate OfficerBoard Member Oct 31, 2018
Cathryn Beer Individual Corporate OfficerBoard Member Oct 26, 2016
Dianna Christenson Individual Corporate OfficerBoard Member Dec 4, 2013
Christopher Adams Individual Corporate OfficerBoard Member Jun 26, 2019
Julie Shaw Individual Corporate OfficerBoard Member Sep 25, 2019
Allen Mott Individual Corporate OfficerBoard Member Mar 28, 2018
Micah Stipech Individual Corporate OfficerBoard Member Mar 25, 2020

Practitioners & affiliated clinicians

Practitioners 82

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 82

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778630400000",
    "number": "1114788619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 E M35",
            "city": "GWINN",
            "state": "MI",
            "postal_code": "498419160",
            "telephone_number": "906-483-1177",
            "fax_number": "906-372-3230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 LAKE LINDEN AVE",
            "city": "LAURIUM",
            "state": "MI",
            "postal_code": "499132614",
            "telephone_number": "906-483-1177",
            "fax_number": "906-372-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER GREAT LAKES FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-22",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A",
        "authorized_official_last_name": "HODGES",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "906-483-1846"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Upper Great Lakes Family Health Mobile Unit 1",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Upper Great Lakes Family Health Mobile Unit 1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laurium, MI

Sources for this page

Verify at the official NPI Registry.