UPPER GREAT LAKES FAMILY HEALTH CENTER (NPI# 1801214218) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801214218 |
| Entity Type | Organization |
| Organization Name | UPPER GREAT LAKES FAMILY HEALTH CENTER |
| Other Organization Name | MENOMINEE FAMILY HEALTH CENTER |
| Practice Address |
1110 10th Ave Menominee MI 49858-3058 |
| Mailing Address |
506 Campus Drive Hancock MI 49930-1569 |
| Practice Telephone | 9062905000 |
| Practice Fax Number | 9068632408 |
| Mailing Telephone | 9064831705 |
| Mailing Fax Number | 9064831394 |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2016-04-18 |
| Authorized Official Name | DONALD A SIMILA (CEO) |
| Authorized Official Telephone | 9064831325 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
MI | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Menominee Family Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053948265 | Upper Great Lakes Family Health Center | Clinic/Center | 1414 W Fair Ave Ste 242, Marquette, MI 49855-5406 | 2020-03-26 |
| 1659889673 | Upper Great Lakes Family Health Center | Psychiatry & Neurology | 965 Fee Rd Rm A229, East Lansing, MI 48824-6410 | 2018-01-11 |
| 1336563832 | Upper Great Lakes Family Health Center | Clinic/Center | 751 S 7th Street, Ontonagon, MI 49953-1450 | 2014-02-05 |
| 1508289273 | Upper Great Lakes Family Health Center | Clinic/Center | 1500 W Ice Lake Road, Iron River, MI 49935-8509 | 2014-01-30 |
| 1740603885 | Upper Great Lakes Family Health Center | Clinic/Center | 945 Ninth Street, Lake Linden, MI 49945-1100 | 2014-01-25 |
| 1811325103 | Upper Great Lakes Family Health Center | Clinic/Center | 600 Macinnes Drive, Houghton, MI 49931-1144 | 2013-10-23 |
| 1700103777 | Upper Great Lakes Family Health Center | Family Medicine | 301 Explorer Street, Gwinn, MI 49841-2813 | 2010-04-29 |
| 1104158690 | Upper Great Lakes Family Health Center | Family Medicine | 135 East M 35, Gwinn, MI 49841-9159 | 2010-02-08 |
| 1396295721 | Upper Great Lakes Family Health Center | Dentist | 56720 Calumet Ave, Calumet, MI 49913-1967 | 2016-10-10 |
| 1164893491 | Upper Great Lakes Family Health Center | Dentist | 301 Explorer St, Gwinn, MI 49841-2813 | 2015-10-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | UPPER GREAT LAKES FAMILY HEALTH CENTER | 506 Campus Dr, Hancock, MI 49930-1569 |
| Street Address |
1110 10TH AVE |
| City | MENOMINEE |
| State | MI |
| Zip Code | 49858-3058 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548261969 | Ray S Koivunen | Family Medicine | 1110 10th Ave, Menominee, MI 49858-3058 | 2005-08-09 |
| 1821545864 | Joshua E Hulkonen | Physician Assistant | 1110 10th Ave, Menominee, MI 49858-3058 | 2016-09-07 |
| 1194763185 | Iron Mountain Vamc | Clinic/Center | 1110 10th Ave, Suite 101, Menominee, MI 49858-3058 | 2006-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942843800 | Lynnette Marie Geib | Technician | N1872 Hwy M-35, Menominee, MI 49858 | 2019-10-23 |
| 1669955514 | Corrina Rae Anderson | Behavior Technician | 1104 16th Ave, Menominee, MI 49858 | 2018-09-06 |
| 1740668565 | Eyecare Services, LLC | Voluntary or Charitable | 3400 North 10th St #73, Menominee, MI 49858 | 2015-05-13 |
| 1922300714 | Great Lakes Recovery Centers, Inc. | Community/Behavioral Health | 3120 10th Street, Suite 2, Menominee, MI 49858 | 2010-11-30 |
| 1295043651 | Andrew John Thanos | Dentist | 1201 10th Street, Menominee, MI 49858 | 2010-09-20 |
| 1962645226 | Mack Occupational Health Services Sc | General Practice | N528 Fairland Island, Menominee, MI 49858 | 2009-04-15 |
| 1194901686 | Bonnie Susan Pulkowski | Nurse Practitioner | 1110 10th Ave Ste 101, Menominee, MI 49858 | 2008-01-14 |
| 1740383207 | Troy R Clausen | Dentist | N166 West Dr, Menominee, MI 49858 | 2006-09-07 |
| 1750483095 | George Swift Harris | Dentist | 2012 10th St, Menominee, MI 49858 | 2006-09-05 |
| 1316912397 | John Owens Beldo | Dentist | 2108 22nd Ave, Menominee, MI 49858 | 2006-02-22 |
| Find all providers in zip 49858 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 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 |
| 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.