NPIMap

Organization Active NPI

Traverse Health Clinic and Coalition

Doing business as Traverse Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Traverse City, MI
National Provider Identifier
1467632059
Registry record updated Dec 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRAVERSE HEALTH CLINIC AND COALITION
Doing business as
Traverse Health Clinic
Practice address
3147 Logan Valley Rd
Traverse City, MI 49684-4772
Phone
(231) 935-0799
Fax
(231) 935-0962
NPI assigned
Nov 12, 2007
Last updated
Dec 11, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2015

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

Authorized official

Name
Mrs. Arlene J. Brennan, MHSA
Title
Ceo
Phone
(231) 935-0351

Specialties & licenses 1

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

Addresses

Primary practice location

3147 Logan Valley Rd
Traverse City, MI 49684-4772

Mailing address

3155 Logan Valley Rd
Traverse City, MI 49684-4772
Phone (231) 935-0799

Other identifiers 10

IdentifierTypeStateIssuer
1437155488MedicaidMI
1841296613MedicaidMI
1265517494MedicaidMI
1891994026MedicaidMI
1669441457MedicaidMI
1730153149MedicaidMI
1255702486MedicaidMI
1619196680MedicaidMI
1972680411MedicaidMI
1760702161MedicaidMI

Other names 1

  • Traverse Health Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

3147 Logan Valley Rd
Traverse City, MI 49684
Phone (231) 935-0668

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1194825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449792000000",
    "number": "1467632059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3155 LOGAN VALLEY RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496844772",
            "telephone_number": "231-935-0799",
            "fax_number": "231-935-0501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3147 LOGAN VALLEY RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496844772",
            "telephone_number": "231-935-0799",
            "fax_number": "231-935-0962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAVERSE HEALTH CLINIC AND COALITION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-12",
        "last_updated": "2015-12-11",
        "status": "A",
        "authorized_official_last_name": "BRENNAN",
        "authorized_official_first_name": "ARLENE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "231-935-0351",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MHSA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437155488",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841296613",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265517494",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891994026",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669441457",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730153149",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255702486",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619196680",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972680411",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760702161",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Traverse Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.