BAY MILLS INDIAN COMMUNITY (NPI# 1053592089) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053592089 |
| Entity Type | Organization |
| Organization Name | BAY MILLS INDIAN COMMUNITY |
| Practice Address |
12124 W Lakeshore Dr Brimley MI 49715-9319 |
| Mailing Address |
12124 W Lakeshore Dr Po Box 138 Brimley MI 49715-9319 |
| Practice Telephone | 9062485527 |
| Practice Fax Number | 9062485765 |
| Mailing Telephone | 9062485527 |
| Mailing Fax Number | 9062485765 |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2017-11-28 |
| Authorized Official Name | AUDREY BREAKIE (HEALTH DIRECTOR) |
| Authorized Official Telephone | 9062488327 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
231839 | MI | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326005273 | Bay Mills Indian Community | Ambulance | 3406 S Pine Village Rd, Brimley, MI 49715-9324 | 2006-04-26 |
| 1952388175 | Bay Mills Indian Community | Clinic/Center | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2005-12-29 |
| 1073711057 | Bay Mills Indian Community | Clinic/Center | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2007-07-11 |
| 1669692554 | Bay Mills Indian Community | Durable Medical Equipment & Medical Supplies | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2007-04-26 |
| 1316904337 | Bay Mills Indian Community | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2006-04-26 |
| 1851358873 | Bay Mills Indian Community | Clinic/Center | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2006-04-26 |
| 1366409237 | Bay Mills Indian Community | Clinic/Center | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2006-04-26 |
| Street Address |
12124 W LAKESHORE DR |
| City | BRIMLEY |
| State | MI |
| Zip Code | 49715-9319 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952388175 | Bay Mills Indian Community | Clinic/Center | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2005-12-29 |
| 1053923763 | Danielle Lynn Leblanc | Nurse Practitioner | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2020-08-24 |
| 1730738089 | Karen Joy Perkins | Nurse Practitioner | 12124 W Lakeshore Dr, Brimley, MI 49715-9403 | 2019-09-10 |
| 1316508690 | Marisol Seys | Dentist | 12124 W Lakeshore Dr, Brimley, MI 49715-9403 | 2019-06-26 |
| 1356830079 | Lindsay Teeple | Dental Hygienist | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2018-05-08 |
| 1255829529 | Lucy Parish Dewildt | Pharmacist | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2018-04-23 |
| 1740707488 | Sherri Larock-macdonald | Social Worker | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2017-08-24 |
| 1134571268 | Cathy Marie Mccoy | Dental Hygienist | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2016-07-13 |
| 1295116515 | Amber Dawn Rivard | Nurse Practitioner | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2015-06-11 |
| 1831577675 | Lynda Gregorini | Dental Hygienist | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2015-05-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689082042 | William L. Malette | Social Worker | 12124 W Lake Shore Drive, Brimley, MI 49715 | 2014-07-30 |
| 1801204276 | Brett Elizabeth Carr | Counselor | 12124 West Lakeshore Drive, Brimley, MI 49715 | 2014-07-29 |
| 1013433846 | Miranda L Johnson | Assistant Behavior Analyst | 9280 S Midway Rd, Brimley, MI 49715-9223 | 2017-08-14 |
| 1649697962 | Jade Seelye | Social Worker | 12124 W. Lakeshore Drive, Brimley, MI 49715-9286 | 2014-03-25 |
| 1083264121 | Kathryn Ludlow | Counselor | 7134 S M 221, Brimley, MI 49715-9299 | 2019-09-19 |
| 1497800163 | James Alfred Leblanc | Marriage & Family Therapist | 12072 W Lakeshore Dr, Brimley, MI 49715-9318 | 2007-01-24 |
| 1326005273 | Bay Mills Indian Community | Ambulance | 3406 S Pine Village Rd, Brimley, MI 49715-9324 | 2006-04-26 |
| 1851752356 | Taylor Mills | Specialist/Technologist | 10331 W Mills Rd, Brimley, MI 49715-9401 | 2016-03-10 |
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952388175 | Bay Mills Indian Community | Clinic/Center | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2005-12-29 |
| 1851358873 | Bay Mills Indian Community | Clinic/Center | 12124 W Lakeshore Dr, Brimley, MI 49715-9319 | 2006-04-26 |
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|---|---|---|---|---|
| 1427658244 | Hackley Community Care Center Inc | Clinic/Center | 3113 Pontaluna Rd Ste A, Fruitport, MI 49415-9600 | 2020-10-30 |
| 1760080972 | Hackley Community Care Center Inc | Clinic/Center | 1420 Madison St Ste A, Muskegon, MI 49442-5251 | 2020-10-12 |
| 1831706993 | Family Medical Center of Michigan, Inc | Clinic/Center | 503 Washington St Rm 150, Monroe, MI 48161-1309 | 2020-09-23 |
| 1326654666 | Family Medical Center of Michigan,inc | Clinic/Center | 550 E Main St Ste 1001, Hudson, MI 49247-9535 | 2020-09-22 |
| 1922613975 | Hackley Community Care Center Inc | Clinic/Center | 6245 Syers Rd Ste A, Holton, MI 49425-7557 | 2020-09-15 |
| 1700400389 | Northwest Michigan Health Services, Inc. | Clinic/Center | 300 W Broadway Ave Trlr 1, Scottville, MI 49454-1019 | 2020-05-30 |
| 1679195721 | Family Medical Center of Michigan,inc | Clinic/Center | 2740 Collingwood St Ste 100, Detroit, MI 48206-1473 | 2020-05-12 |
| 1235750571 | Great Lakes Bay Health Centers | Clinic/Center | 2300 Veterans Memorial Pkwy, Saginaw, MI 48601-1268 | 2020-04-28 |
| 1053948265 | Upper Great Lakes Family Health Center | Clinic/Center | 1414 W Fair Ave Ste 242, Marquette, MI 49855-5406 | 2020-03-26 |
| 1568096923 | Grace Health, Inc. | Clinic/Center | 825 Capital Ave Ne, Battle Creek, MI 49017-5605 | 2020-02-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.