Uscg Clinic Sector Detroit

Primary specialty

Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X

License

4301062131 Issued in MI

Legal business name

USCG CLINIC SECTOR DETROIT

Practice address

43401 N. Jefferson, BLDG 825
Selfridge Angb, MI 48045

Phone

(586) 307-5017

Fax

(586) 307-5010

NPI assigned

Nov 29, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Joseph P Simon, M.D.

Title

Chief, Health Services Division

Phone

(586) 307-5017

Specialties & licenses 1

Addresses

Tax ID family

Uscg Clinic St Petersburg65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 1

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Uscg Airsta Traverse City Clinic

  • Health Service Clinic/Center
  • Traverse City, MI
  • NPI 1942384409
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brandon Charles Holda

  • Other Technician
  • Selfridge Angb, MI
  • NPI 1629241559
  NPD (past)

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477620755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43401 N. JEFFERSON, BLDG 825",
            "city": "SELFRIDGE ANGB",
            "state": "MI",
            "postal_code": "48045",
            "telephone_number": "586-307-5017",
            "fax_number": "586-307-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43401 N. JEFFERSON, BLDG 825",
            "city": "SELFRIDGE ANGB",
            "state": "MI",
            "postal_code": "48045",
            "telephone_number": "586-307-5017",
            "fax_number": "586-307-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "USCG CLINIC SECTOR DETROIT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF, HEALTH SERVICES DIVISION",
        "authorized_official_telephone_number": "586-307-5017",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": "MI",
            "license": "4301062131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Lindsay Hodges, LLMSW
• Brandon Charles Holda
• Diana Lee Kott, RDH
• Dana Marie Kubinski, RDH
• Moriah, Incorporated

• Military/U.S. Coast Guard Outpatient Clinic/Center in Selfridge Angb, MI
• Providers in Selfridge Angb, MI by specialty
• Military/U.S. Coast Guard Outpatient Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.