Intercare Community Health Network Dental Van
Organization Active NPI Federally Qualified Health Center (FQHC) · Bangor, MI
NPI 1194133744 · NPPES record last updated Jul 28, 2014
Key facts
- NPI
- 1194133744
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- INTERCARE COMMUNITY HEALTH NETWORK DENTAL VAN
- Practice address
- 308 Charles Street
Bangor, MI 49013-1246 - Phone
- (269) 427-7937
- Fax
- (269) 427-5180
- NPI assigned
- Jul 28, 2014
- Organization subpart
- No
Authorized official
- Name
- Velma Hendershott
- Title
- Ceo/President
- Phone
- (269) 427-7937
Corporate family (same tax ID) 15
National Provider Directory
- Tax ID family
- Intercare Community Health Network
Locations
308 Charles St
Bangor, MI 49013
Phone (269) 427-7967
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
308 Charles Street
Bangor, MI 49013-1246
Mailing address
50 Industrial Park Rd
Bangor, MI 49013-1246
Phone (269) 427-7937
Other providers in Bangor, MI
- Amy Howay
- Holly Husted
- Intercare Community Health Network
- Intercare Community Health Network
- Intercare Community Health Network
- Intercare Community Heath Network Medical Van
- Charles David Johns
- Amy Jo Johnson
- David Andrew Kalafut
- Victoria Ann Kerr
All providers in Bangor, MI · Federally Qualified Health Center (FQHC) in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.