Sault Tribe of Chippewa Indians
Organization Active NPI Federally Qualified Health Center (FQHC) · De Tour Village, MI
NPI 1861545337 · NPPES record last updated Jul 10, 2007
Key facts
- NPI
- 1861545337
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 231875
- Legal business name
- SAULT TRIBE OF CHIPPEWA INDIANS
- Practice address
- 346 Superior St
De Tour Village, MI 49725 - Phone
- (906) 297-3204
- NPI assigned
- Jan 19, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- SAULT TRIBE OF CHIPPEWA INDIANS
Authorized official
- Name
- Bonnie Culfa, RN MSN
- Title
- Health Director
- Phone
- (906) 632-5200
Other NPIs on the same Medicare enrollment 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
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 |
National Provider Directory
- Part of
- Sault Ste Marie Tribe O
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 231875 | Yes |
Addresses
Primary practice location
346 Superior St
De Tour Village, MI 49725
Mailing address
346 Superior St
De Tour Village, MI 49725
Phone (906) 297-3204
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 231875 | Other | MI | FQHC FACILITY NUMBER |
Other names
- DeTour Village Medical Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2007. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.