Active NPI
Grand Traverse Band of Ottawa and Chippewa Indians
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
- Peshawbestown, MI
National Provider Identifier
1669227203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
- Legal business name
- GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS
- Practice address
- 2300 N Stallman Rd
Peshawbestown, MI 49682-9158 - Phone
- (231) 534-7350
- Fax
- (231) 534-7351
- NPI assigned
- Apr 18, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kimberly Jane Hines, RPH
- Title
- Pharmacy Manager
- Phone
- (231) 543-7350
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 332800000X | Primary | ||
| Clinic Pharmacy | 3336C0002X |
Addresses
Primary practice location
2300 N Stallman Rd
Peshawbestown, MI 49682-9158
Mailing address
2300 N Stallman Rd
Peshawbestown, MI 49682-9158
Phone (231) 534-7350
National Provider Directory
National Provider Directory- Tax ID family
- Grand Traverse Band of Ottawa and Chippewa Indians
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Psychiatric/Mental Health Registered Nurse
- Peshawbestown, MI
- NPI 1477227239
-
- Dental Clinic/Center
- Peshawbestown, MI
- NPI 1508126517
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713398400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1772064000000",
"number": "1669227203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 N STALLMAN RD",
"city": "PESHAWBESTOWN",
"state": "MI",
"postal_code": "496829158",
"telephone_number": "231-534-7350",
"fax_number": "231-534-7351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 N STALLMAN RD",
"city": "PESHAWBESTOWN",
"state": "MI",
"postal_code": "496829158",
"telephone_number": "231-534-7350",
"fax_number": "231-534-7351"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS",
"organizational_subpart": "NO",
"enumeration_date": "2024-04-18",
"last_updated": "2026-02-26",
"certification_date": "2026-02-26",
"status": "A",
"authorized_official_last_name": "HINES",
"authorized_official_first_name": "KIMBERLY",
"authorized_official_middle_name": "JANE",
"authorized_official_title_or_position": "PHARMACY MANAGER",
"authorized_official_telephone_number": "231-543-7350",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "332800000X",
"taxonomy_group": "",
"desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
"state": null,
"license": null,
"primary": true
},
{
"code": "3336C0002X",
"taxonomy_group": "",
"desc": "Pharmacy, Clinic Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peshawbestown, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.