LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS


Address: 1250 Lears Rd., Petoskey, MI 49770-8774
Phone: 2312421700

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QF0400X Clinic/Center
Specialization: Federally Qualified Health Center (FQHC)
Ambulatory Health Care Facilities

Other Provider IDs and Locations

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

Other Data Sources

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

Office Location

Street Address 1250 LEARS RD.
City PETOSKEY
State MI
Zip Code 49770-8774

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
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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
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Taxonomy Information

Taxonomy Code 261QF0400X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Federally Qualified Health Center (FQHC)

Taxonomy Definition

Definition to come...

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Competitor

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City PETOSKEY
Zip Code 49770

Improve Information

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Dataset Information

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.

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