NPIMap

Organization Active NPI

Great Lakes Bay Health Centers

Doing business as Great Lakes Bay Health Centers Imlay City

  • Federally Qualified Health Center (FQHC)
  • Imlay City, MI
National Provider Identifier
1710181128
Registry record updated Sep 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREAT LAKES BAY HEALTH CENTERS
Doing business as
Great Lakes Bay Health Centers Imlay City
Practice address
6800 Newark Rd
Suite 200
Imlay City, MI 48444-9656
Phone
(810) 724-3201
Fax
(810) 724-4605
NPI assigned
Jun 12, 2007
Last updated
Sep 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2016

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

Authorized official

Name
Lisa Galonska
Title
Vice President
Phone
(989) 759-6464

Specialties & licenses 1

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

Addresses

Primary practice location

6800 Newark Rd
Suite 200
Imlay City, MI 48444-9656

Mailing address

501 Lapeer
Saginaw, MI 48607
Phone (989) 759-6464

Other identifiers 1

IdentifierTypeStateIssuer
0G36111OtherMI0G36111 MEDICARE PAY BILL TO

Other names 1

  • Great Lakes Bay Health Centers Imlay City Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120131000625 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 Practice locations: Imlay City, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710181128. Details of each certification follow.

Federally qualified health center certification: CCN 231967

Legal name
GREAT LAKES BAY HEALTH CENTERS
Doing business as
GREAT LAKES BAY HEALTH CENTERS IMLAY CITY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 31, 2012
Last certification
Mar 31, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1968 in MI
Enrollment address
6800 Newark Rd
Ste 200
Imlay City, MI 48444-9656

National Provider Directory

National Provider Directory
Tax ID family
Great Lakes Bay Health Centers67 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Scott Gilman Individual Corporate Director Jul 1, 2010
Lottie Hairston Individual Corporate Officer Oct 4, 2004
Theresa Vaughn Individual Corporate Director Feb 1, 2007
Gilbert G Flores Individual Corporate Director Jul 1, 2006
Earl J Sams Individual Corporate DirectorVice Chairman of Board Jun 1, 2002
Saleem a Mannan Individual Corporate OfficerChair of the Board Dec 1, 2011
Lisa Galonska Individual Corporate Officer Dec 1, 2011
Janis Wilcox Individual W-2 Managing Employee Dec 1, 2011

NPI Registry JSON

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1710181128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 LAPEER",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "48607",
            "telephone_number": "989-759-6464",
            "fax_number": "989-399-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 NEWARK RD",
            "address_2": "SUITE 200",
            "city": "IMLAY CITY",
            "state": "MI",
            "postal_code": "484449656",
            "telephone_number": "810-724-3201",
            "fax_number": "810-724-4605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES BAY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-12",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "GALONSKA",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "989-759-6464"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "0G36111 MEDICARE PAY BILL TO",
            "identifier": "0G36111",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Bay Health Centers Imlay City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Imlay City, MI

Sources for this page

Verify at the official NPI Registry.