| NPI | 1114217833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY MAYO Interim Health Administrator 906-353-8700 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2017-12-20 |