Provider Demographics
NPI:1457136418
Name:BAY MILLS INDIAN COMMUNITY
Entity Type:Organization
Organization Name:BAY MILLS INDIAN COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT HHS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:PARISH
Authorized Official - Last Name:DEWILDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-248-8372
Mailing Address - Street 1:12455 W LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:BRIMLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49715-9327
Mailing Address - Country:US
Mailing Address - Phone:906-248-8366
Mailing Address - Fax:
Practice Address - Street 1:204 E PORTAGE AVE
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-2054
Practice Address - Country:US
Practice Address - Phone:906-248-8621
Practice Address - Fax:906-248-8622
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY MILLS INDIAN COMMUNITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy