LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS (NPI# 1124052816) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124052816 |
| Entity Type | Organization |
| Organization Name | LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS |
| Practice Address |
1250 Lears Rd. Petoskey MI 49770-8774 |
| Mailing Address |
7500 Odawa Cir Attn: Billing Harbor Springs MI 49740-9692 |
| Practice Telephone | 2312421700 |
| Practice Fax Number | 2312421717 |
| Mailing Telephone | 2312421611 |
| Mailing Fax Number | 2312421730 |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2015-01-29 |
| Authorized Official Name | DR. TERRY SAMUELS (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 2312421700 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235342866 | Little Traverse Bay Bands of Odawa Indians | Community/Behavioral Health | 101 Greenwood, Petoskey, MI 49770 | 2007-05-08 |
| 1588108260 | Little Traverse Bay Bands of Odawa Indians | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1250 Lears Rd, Petoskey, MI 49770-9252 | 2016-12-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS | 7500 Odawa Cir, Harbor Springs, MI 49740-9692 |
| Street Address |
1250 LEARS RD. |
| City | PETOSKEY |
| State | MI |
| Zip Code | 49770-8774 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780231985 | Olivia Michelle Seaman | Pharmacist | 1301 U.S. 31 N. Hwy, Petoskey, MI 49770 | 2019-08-22 |
| 1649733148 | Harbor Hall, Inc. | Clinic/Center | 302 Orchard Ridge Drive, Petoskey, MI 49770 | 2019-04-11 |
| 1053802942 | Devin Hueston | Dentist | 231 State St Ste 3, Petoskey, MI 49770 | 2018-05-25 |
| 1720585037 | Jacob Kenneth Tracy | Counselor | 410 E Lake Street, Suite 100, Petoskey, MI 49770 | 2018-04-12 |
| 1013424191 | Timothy Robert La Gasse | Nurse Practitioner | 401 Connable Ave, Petoskey, MI 49770 | 2018-01-10 |
| 1609303676 | Shauna Sue Stark | Nurse Practitioner | 560 W Mitchell St Ste 505, Petoskey, MI 49770 | 2017-05-22 |
| 1053851519 | Maureen Todd | Counselor | 703 Emmet St, Petoskey, MI 49770 | 2017-03-03 |
| 1457719239 | Hufford Vision & Eye Care, PC | Optometrist | 560 West Mitchell, Suite 214, Petoskey, MI 49770 | 2016-02-08 |
| 1053779439 | Kaylyn Schiemann | Specialist/Technologist | 1980 Maxwell Rd, Petoskey, MI 49770 | 2016-02-01 |
| 1669839130 | Stieber Pediatric Dentistry Pllc | Clinic/Center | 1605 Us 131 Highway, Petoskey, MI 49770 | 2016-01-28 |
| Find all providers in zip 49770 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
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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.