| NPI | 1508289273 |
|---|---|
| Doing Business As | ICE LAKE FAMILY HEALTH CENTER |
| Entity Type | Organization |
| Authorized Contact | TREVOR HODGES CEO 906-483-1846 |
| 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 | 2025-07-10 |