Hannahville Indian Community

Primary specialty

Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X

License

5301006526 Issued in MI

Legal business name

HANNAHVILLE INDIAN COMMUNITY

Doing business as

Hannahville Health Center Pharmacy

Practice address

W365 US 2 & 41
Suite 600
Wilson, MI 49896

Phone

(906) 723-2560

Fax

(906) 723-2566

NPI assigned

Aug 18, 2006

Last updated

Apr 6, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gayle Meshigaud

Title

Director of Health and Human Servic

Phone

(906) 723-2500

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• HANNAHVILLE HEALTH CENTER PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922112812. Details of each certification follow.

• CCN 231840 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 231840

Legal name

HANNAHVILLE INDIAN COMMUNITY

Doing business as

HANNAHVILLE HEALTH CENTER

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

OtherNon-profit

Enrollment address

N15019 Hannahville B1 Rd
Wilson, MI 49896-9614

Other NPIs on the same Medicare enrollment 1

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

• Hannahville Indian Community

  dba Hannahville Health Center

  • Federally Qualified Health Center (FQHC)
  • Wilson, MI
  • NPI 1790869436

  O20101123000082

  Same enrollment

Tax ID family

Hannahville Health Clin4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Hannahville Health Center Pharmacy

  • Clinic/Center
  • Wilson, MI
  • NPI 1467551291
  NPD tax ID
• Hannahville Indian Community

  dba Hannahville Behavioral Health

  • Community/Behavioral Health Agency
  • Wilson, MI
  • NPI 1457434243
  NPD tax ID
• Hannahville Indian Community

  dba Hannahville Health Center

  • Federally Qualified Health Center (FQHC)
  • Wilson, MI
  • NPI 1790869436
  NPD tax ID

Locations

All disclosed owners & managing parties 4

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Hannahville Indian Community

  dba Hannahville Health Center

  • Federally Qualified Health Center (FQHC)
  • Wilson, MI
  • NPI 1790869436

  General Partnership Interest

  CMS ownership

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491436800000",
    "number": "1922112812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W365 US 2&41",
            "address_2": "SUITE 600",
            "city": "WILSON",
            "state": "MI",
            "postal_code": "49896",
            "telephone_number": "906-723-2560",
            "fax_number": "906-723-2566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W365 US 2 & 41",
            "address_2": "SUITE 600",
            "city": "WILSON",
            "state": "MI",
            "postal_code": "49896",
            "telephone_number": "906-723-2560",
            "fax_number": "906-723-2566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HANNAHVILLE INDIAN COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2017-04-06",
        "status": "A",
        "authorized_official_last_name": "MESHIGAUD",
        "authorized_official_first_name": "GAYLE",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTH AND HUMAN SERVIC",
        "authorized_official_telephone_number": "906-723-2500"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "MI",
            "license": "5301006526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2043505",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3318839",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HANNAHVILLE HEALTH CENTER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Erin Lee Cretens, LMSW
• Erin Marie Davis, M.S., R.D.
• Hannahville Health Center Pharmacy
• Hannahville Indian Community (Hannahville Behavioral Health)
• Hannahville Indian Community (Hannahville Health Center)
• Kelli M Jackson, CBD
• Vanessa J Jesse, CIBD FSID
• Jennifer Keshick
• Lori Jean Macintosh, RN
• Mary Susanne Miller, M.A., L.L.P.

• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Wilson, MI
• Providers in Wilson, MI by specialty
• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2017; 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.