Provider Demographics
NPI:1790837177
Name:ONTONAGON COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:ONTONAGON COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:A. GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-225-4821
Mailing Address - Street 1:751 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTONAGON
Mailing Address - State:MI
Mailing Address - Zip Code:49953-1450
Mailing Address - Country:US
Mailing Address - Phone:906-884-4120
Mailing Address - Fax:906-884-2861
Practice Address - Street 1:751 S 7TH ST
Practice Address - Street 2:
Practice Address - City:ONTONAGON
Practice Address - State:MI
Practice Address - Zip Code:49953-1450
Practice Address - Country:US
Practice Address - Phone:906-884-4120
Practice Address - Fax:906-884-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M76190OtherMEDICARE GROUP
MI0806600051OtherBLUE CROSS BLUE SHIELD
MI0M76190002Medicare PIN