Provider Demographics
NPI:1508162561
Name:DICKINSON COUNTY HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:DICKINSON COUNTY HEALTHCARE SYSTEM
Other - Org Name:DICKINSON MEDICAL SERVICES AT BAYSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-774-1313
Mailing Address - Street 1:2001 MINNEAPOLIS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GLADSTONE
Mailing Address - State:MI
Mailing Address - Zip Code:49837-2060
Mailing Address - Country:US
Mailing Address - Phone:906-776-5640
Mailing Address - Fax:906-776-5639
Practice Address - Street 1:2001 MINNEAPOLIS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:GLADSTONE
Practice Address - State:MI
Practice Address - Zip Code:49837-2060
Practice Address - Country:US
Practice Address - Phone:906-776-5640
Practice Address - Fax:906-776-5639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DICKINSON COUNTY HEALTHCARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-08
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI220020261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology