Upper Great Lakes Family Health Center
Organization Active NPI Psychiatry Physician · East Lansing, MI
NPI 1659889673 · NPPES record last updated Jun 19, 2024
Key facts
- NPI
- 1659889673
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- UPPER GREAT LAKES FAMILY HEALTH CENTER
- Practice address
- 965 Fee Rd RM A229
East Lansing, MI 48824-6410 - Phone
- (906) 483-1177
- Fax
- (906) 481-3094
- NPI assigned
- Jan 11, 2018
- Organization subpart
- No
Authorized official
- Name
- Rebecca Gaffney
- Title
- Business Office Director
- Phone
- (906) 481-8585
Other NPIs on the same Medicare enrollment 10
Practitioners 2
-
Whitney J Brey, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100629000853 | MI | Part B Supplier - Clinic/Group Practice | 1951432384 |
Receives reassigned benefits from 63 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Menominee, MI; Marquette, MI; Gwinn, MI; Iron River, MI; East Lansing, MI; Calumet, MI; Hancock, MI |
National Provider Directory
Locations
506 Campus Dr
Hancock, MI 49930
Phone (906) 483-1000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | Yes |
Addresses
Primary practice location
965 Fee Rd RM A229
East Lansing, MI 48824-6410
Mailing address
301 Explorer St
Gwinn, MI 49841-2813
Phone (906) 481-8586
Other names
- UGL MSU Tele-Psychiatry
NPI Registry JSON
{
"created_epoch": "1515628800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1718755200000",
"number": "1659889673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 EXPLORER ST",
"city": "GWINN",
"state": "MI",
"postal_code": "498412813",
"telephone_number": "906-481-8586",
"fax_number": "906-483-1394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "965 FEE RD RM A229",
"city": "EAST LANSING",
"state": "MI",
"postal_code": "488246410",
"telephone_number": "906-483-1177",
"fax_number": "906-481-3094"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "UPPER GREAT LAKES FAMILY HEALTH CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2018-01-11",
"last_updated": "2024-06-19",
"certification_date": "2024-06-19",
"status": "A",
"authorized_official_last_name": "GAFFNEY",
"authorized_official_first_name": "REBECCA",
"authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
"authorized_official_telephone_number": "906-481-8585"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "UGL MSU Tele-Psychiatry",
"code": "3",
"type": "Doing Business As"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.