Provider Demographics
NPI:1659868206
Name:MACKINAC STRAITS HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:MACKINAC STRAITS HEALTH SYSTEM INC
Other - Org Name:ST. IGNACE MEDICAL CLINIC, ANNEX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING AND ENROLLMENTS
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-643-0451
Mailing Address - Street 1:1140 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781-1048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1140 N STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1048
Practice Address - Country:US
Practice Address - Phone:906-643-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MACKINAC STRAITS HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-19
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
238716OtherMEDICARE