NPIMap

Organization Active NPI

Sault Tribe of Chippewa Indians

  • Clinical Medical Laboratory
  • Sault Sainte Marie, MI
National Provider Identifier
1750434395
Registry record updated Dec 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
23D0674935 Issued in MI
Legal business name
SAULT TRIBE OF CHIPPEWA INDIANS
Practice address
2864 Ashmun St
Sault Sainte Marie, MI 49783-3740
Phone
(906) 632-5200
Fax
(906) 632-5276
NPI assigned
Jan 18, 2007
Last updated
Dec 27, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
SAULT TRIBE OF CHIPPEWA INDIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 27, 2007

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

Authorized official

Name
Bonnie L Culfa, RN MSN
Title
Health Director
Phone
(906) 632-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 23D0674935 MI Primary

Addresses

Primary practice location

2864 Ashmun St
Sault Sainte Marie, MI 49783-3740

Mailing address

2864 Ashmun St
Sault Sainte Marie, MI 49783-3740
Phone (906) 632-5200

Other identifiers 3

IdentifierTypeStateIssuer
0A71500OtherMIBLUE CROSS & BLUE SHIELD
3516048MedicaidMI
23D0674935OtherMICLIA NUMBER

Other names 1

  • Sault Tribal Health Center Laboratory Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051021000788 MI Part B Supplier - Independent Clinical Laboratory 7012982937 Practice locations: Sault Sainte Marie, MI

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0674935Sault Ste Marie Tribal HLTH Human Services2864 Ashmun St, Sault Sainte Marie, MI 49783AccreditationJun 1, 2028
23D0865798Sault Tribe Community Health Program2864 Ashmun Street, Sault Sainte Marie, MI 49783Certificate of waiverMar 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Original Band of Sault16 organizations share this tax ID, including this one
Part of
Original Band of Sault

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sault Tribe of Chippewa IndiansSault Sainte Marie, MI, CCN 231838 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1994
Sault Tribe of Chippewa IndiansManistique, MI, CCN 231842 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1994
Sault Tribe of Chippewa IndiansMunising, MI, CCN 231843 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 25, 2007
Sault Tribe of Chippewa IndiansHessel, MI, CCN 231923 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 5, 2007
Sault Tribe of Chippewa IndiansNewberry, MI, CCN 231922 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 5, 2007
Sault Tribe of Chippewa IndiansSaint Ignace, MI, CCN 231841 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1994

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198713600000",
    "number": "1750434395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2864 ASHMUN ST",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497833740",
            "telephone_number": "906-632-5200",
            "fax_number": "906-632-5276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2864 ASHMUN ST",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497833740",
            "telephone_number": "906-632-5200",
            "fax_number": "906-632-5276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAULT TRIBE OF CHIPPEWA INDIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAULT TRIBE OF CHIPPEWA INDIANS",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-12-27",
        "status": "A",
        "authorized_official_last_name": "CULFA",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "HEALTH DIRECTOR",
        "authorized_official_telephone_number": "906-632-5200",
        "authorized_official_credential": "RN MSN"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MI",
            "license": "23D0674935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "0A71500",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3516048",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "23D0674935",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sault Tribal Health Center Laboratory",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sault Sainte Marie, MI

Sources for this page

Verify at the official NPI Registry.