NPIMap

Organization Active NPI

Match-E-Be-Nash-She-Wish Band of Pottawatomi Indians

  • Pharmacy
  • Shelbyville, MI
National Provider Identifier
1689232241
Registry record updated May 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
MATCH-E-BE-NASH-SHE-WISH BAND OF POTTAWATOMI INDIANS
Practice address
2880 Mission Dr
Shelbyville, MI 49344-9580
Phone
(269) 397-1760
NPI assigned
May 30, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2019

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

Authorized official

Name
Kelly Wesaw
Title
Health and Human Services Director
Phone
(269) 397-1760

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary

Addresses

Primary practice location

2880 Mission Dr
Shelbyville, MI 49344-9580

Mailing address

2880 Mission Dr
Shelbyville, MI 49344-9580
Phone (269) 397-1760

Other names 1

  • Gun Lake Tribe Pharmacy Other name

National Provider Directory

National Provider Directory
Tax ID family
Match-E-Be-Nash-She-Wish Band of Pottawatomi Indians2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559174400000",
    "number": "1689232241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2880 MISSION DR",
            "city": "SHELBYVILLE",
            "state": "MI",
            "postal_code": "493449580",
            "telephone_number": "269-397-1760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2880 MISSION DR",
            "city": "SHELBYVILLE",
            "state": "MI",
            "postal_code": "493449580",
            "telephone_number": "269-397-1760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATCH-E-BE-NASH-SHE-WISH BAND OF POTTAWATOMI INDIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-30",
        "last_updated": "2019-05-30",
        "status": "A",
        "authorized_official_last_name": "WESAW",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "HEALTH AND HUMAN SERVICES DIRECTOR",
        "authorized_official_telephone_number": "269-397-1760"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gun Lake Tribe Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Shelbyville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2019; 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.