Sault Tribe of Chippewa Indians

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 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

Last updated

Jul 10, 2007By the provider in NPPES

Organization subpart

Yes

Parent organization

SAULT TRIBE OF CHIPPEWA INDIANSAs reported in NPPES

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

Authorized official

Name

Bonnie Culfa, RN MSN

Title

Health Director

Phone

(906) 632-5200

Specialties & licenses 1

Addresses

Other names 1

• DeTour Village Medical Center Other name

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861545337. Details of each certification follow.

• CCN 231875 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 231875

Legal name

DETOUR VILLAGE MEDICAL CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

May 5, 2000

Last certification

May 5, 2000

Ownership / control type

For profit – corporation

Facility address

346 Superior
De Tour Village, MI 49725

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Sault Tribe of Chippewa Indians

  dba Kinross Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Kincheloe, MI
  • NPI 1477605137

  O20040901001322

  Same enrollment
• Sault Tribe of Chippewa Indians

  • Federally Qualified Health Center (FQHC)
  • Sault Sainte Marie, MI
  • NPI 1477721058

  O20040901001322

  Same enrollment
• Sault Tribe of Chippewa Indians

  dba Sault Tribal Health Center

  • Federally Qualified Health Center (FQHC)
  • Sault Sainte Marie, MI
  • NPI 1518922525

  O20040901001322

  Same enrollment
• Sault Tribe of Chippewa Indians

  dba Manistique Tribal Health Center

  • Federally Qualified Health Center (FQHC)
  • Manistique, MI
  • NPI 1588717839

  O20040901001322

  Same enrollment
• Sault Tribe of Chippewa Indians

  • Federally Qualified Health Center (FQHC)
  • Munising, MI
  • NPI 1780737403

  O20040901001322

  Same enrollment
• Sault Tribe of Chippewa Indians

  dba St. Ignace Tribal Health Center

  • Federally Qualified Health Center (FQHC)
  • Saint Ignace, MI
  • NPI 1891847067

  O20040901001322

  Same enrollment

Part of

Sault Tribe of Indians

Locations

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1861545337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "346 SUPERIOR ST",
            "city": "DE TOUR VILLAGE",
            "state": "MI",
            "postal_code": "49725",
            "telephone_number": "906-297-3204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "346 SUPERIOR ST",
            "city": "DE TOUR VILLAGE",
            "state": "MI",
            "postal_code": "49725",
            "telephone_number": "906-297-3204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAULT TRIBE OF CHIPPEWA INDIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAULT TRIBE OF CHIPPEWA INDIANS",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "CULFA",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "HEALTH DIRECTOR",
        "authorized_official_telephone_number": "906-632-5200",
        "authorized_official_credential": "RN MSN"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": "231875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DeTour Village Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.