Provider Demographics
NPI:1205004884
Name:SAULT TRIBE OF CHIPPEWA INDIANS
Entity Type:Organization
Organization Name:SAULT TRIBE OF CHIPPEWA INDIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION OF HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CULFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-632-5200
Mailing Address - Street 1:2864 ASHMUN ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-3740
Mailing Address - Country:US
Mailing Address - Phone:906-632-5200
Mailing Address - Fax:906-632-5276
Practice Address - Street 1:2864 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-3740
Practice Address - Country:US
Practice Address - Phone:906-632-5200
Practice Address - Fax:906-632-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A71016OtherBC/BS OF MI
MI0A71016OtherBC/BS OF MI
MI231843Medicare Oscar/Certification
231922Medicare Oscar/Certification
MI231841Medicare Oscar/Certification
231838Medicare Oscar/Certification
MI0N23850Medicare PIN
MI231842Medicare Oscar/Certification