Sault Tribe of Chippewa Indians
Organization Active NPI Federally Qualified Health Center (FQHC) · Munising, MI
NPI 1780737403 · NPPES record last updated Oct 18, 2024
Key facts
- NPI
- 1780737403
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 231843 (MI)
- Legal business name
- SAULT TRIBE OF CHIPPEWA INDIANS
- Practice address
- 622 W Superior St
Munising, MI 49862-1329 - Phone
- (906) 387-4614
- Fax
- (906) 387-4727
- NPI assigned
- Jan 18, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- SAULT TRIBE OF CHIPPEWA INDIANS
Authorized official
- Name
- Joel Lumsden
- Title
- Assistant Health Director
- Phone
- (906) 632-5200
Owners & managing parties with NPI records 6
Other NPIs on the same Medicare enrollment 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Federally qualified health center certification: CCN 231843
- Legal name
- SAULT TRIBE OF CHIPPEWA INDIANS
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Proprietary
- Enrollment address
- 622 W Superior St
Munising, MI 49862-1329
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Joel Lumsden |
Corporate Director |
Oct 1, 2016 | 10% |
| Jacquelyn S McLean |
W-2 Managing Employee |
Oct 1, 1993 | 10% |
| Sault Tribe of Chippewa Indians |
5% Or Greater Direct Ownership Interest | Jun 25, 2007 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040901001322 | MI | Part B Supplier - Clinic/Group Practice | 7012982937 |
Receives reassigned benefits from 17 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Sault S Marie, MI |
| O20070425000032 | MI | Part a Provider - Federally Qualified Health Center (FQHC) | 7012982937 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Munising, MI |
National Provider Directory
- Part of
- Sault Ste Marie Tribe O
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 231843 | MI | Yes |
Addresses
Primary practice location
622 W Superior St
Munising, MI 49862-1329
Mailing address
622 W Superior St
Munising, MI 49862-1329
Phone (906) 387-4614
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 231843 | Other | UGS |
Other names
- Munising Tribal Health Center
Other providers in Munising, MI
- Putvin Health Mart of Munising Inc
- Chelsea Elise Ray
- Nicole Roth
- Walter William Rudzinski
- Kareem Said
- George Schultz
- Joseph Michael Shaw II
- Natalie Martine Stark
- Bridget Stoetzer
- Superior Mobile Diagnostics LLC
All providers in Munising, MI · Federally Qualified Health Center (FQHC) in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.