NPIMap

Organization Active NPI

Midmichigan Health Services

Doing business as MidMichigan Health Services Houghton Lake Community Schools

  • Federally Qualified Health Center (FQHC)
  • Houghton Lake, MI
National Provider Identifier
1316104995
Registry record updated May 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MIDMICHIGAN HEALTH SERVICES
Doing business as
MidMichigan Health Services Houghton Lake Community Schools
Practice address
4433 W Houghton Lake Dr
Houghton Lake, MI 48629-9786
Phone
(989) 366-2003
Fax
(989) 422-4378
NPI assigned
May 21, 2008
Last updated
May 27, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2008

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

Authorized official

Name
Darrell E Milner, MPH
Title
Executive Director
Phone
(989) 422-5148

Specialties & licenses 1

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

Addresses

Primary practice location

4433 W Houghton Lake Dr
Houghton Lake, MI 48629-9786

Mailing address

9249 W Lake City Rd
Houghton Lake, MI 48629-9602
Phone (989) 422-5122

Other names 1

  • MidMichigan Health Services Houghton Lake Community Schools Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040130001007 MI Part B Supplier - Clinic/Group Practice 7911800495 Receives reassigned benefits from 38 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beaverton, MI; Houghton Lake, MI; Midland, MI; Roscommon, MI; West Branch, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316104995. Details of each certification follow.

  • CCN 231919 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 231919

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MID-MICHIGAN HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 13, 2007
Last certification
Feb 13, 2007
Ownership / control type
For profit – corporation
Facility address
4433 W Houghton Lake Drive
Houghton Lake, MI 48629

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

4433 W Houghton Lake Dr
Houghton Lake, MI 48629
Phone (989) 366-2003

NPI Registry JSON

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

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211846400000",
    "number": "1316104995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9249 W LAKE CITY RD",
            "city": "HOUGHTON LAKE",
            "state": "MI",
            "postal_code": "486299602",
            "telephone_number": "989-422-5122",
            "fax_number": "989-422-6838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4433 W HOUGHTON LAKE DR",
            "city": "HOUGHTON LAKE",
            "state": "MI",
            "postal_code": "486299786",
            "telephone_number": "989-366-2003",
            "fax_number": "989-422-4378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDMICHIGAN HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-21",
        "last_updated": "2008-05-27",
        "status": "A",
        "authorized_official_last_name": "MILNER",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "989-422-5148",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MidMichigan Health Services Houghton Lake Community Schools",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Houghton Lake, MI

Sources for this page

Verify at the official NPI Registry.