Provider Demographics
NPI:1235208075
Name:NORTHWEST MICHIGAN HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:NORTHWEST MICHIGAN HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-947-1112
Mailing Address - Street 1:119 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MI
Mailing Address - Zip Code:49455-1243
Mailing Address - Country:US
Mailing Address - Phone:231-861-2139
Mailing Address - Fax:
Practice Address - Street 1:119 S STATE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MI
Practice Address - Zip Code:49455-1243
Practice Address - Country:US
Practice Address - Phone:231-861-2139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
MI5601004803261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2930590Medicaid
MI4899909Medicaid
MI4109055Medicaid
MI5197132Medicaid
MI4109046Medicaid
MI4410670Medicaid
MI4518234Medicaid
MI3291322Medicaid
MI4410689Medicaid
MI4301085193Medicaid
MI4202541Medicaid
MI4704133105Medicaid
MI4704076658Medicaid
MI2932773Medicaid
MI4518225Medicaid
MI4704127539Medicaid
MI4704076658Medicaid