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905 W Lincoln Ave Cheboygan MI 49721-1858 | |
(989) 354-2197 | |
(989) 356-6524 |
Full Name | |
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Speciality | Clinic/Center |
Location | 905 W Lincoln Ave, Cheboygan, Michigan |
Authorized Official Name and Position | Richard Bates (INTERIM CEO) |
Authorized Official Contact | 9897424583 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 427 Hillman MI 49746-0427 Ph: (989) 354-2197 | 905 W Lincoln Ave Cheboygan MI 49721-1858 Ph: (989) 354-2197 |
NPI Number | 1306244108 |
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Provider Enumeration Date | 12/10/2014 |
Last Update Date | 03/13/2023 |
Medicare PECOS PAC ID | 0143296772 |
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Medicare Enrollment ID | O20150216001765 |
Identifier | Type | State | Issuer |
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1306244108 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Leja Jackson Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 920 S Huron St, Cheboygan, MI 49721 Phone: 231-597-8192 Fax: 231-597-8463 | |