| NPI | 1508289273 |
|---|---|
| Doing Business As | ICE LAKE FAMILY HEALTH CENTER |
| Entity Type | Organization |
| Authorized Contact | DONALD A SIMILA CEO 906-483-1325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2014-01-30 |
| Last Update Date | 2024-11-11 |