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920 S Huron St Cheboygan MI 49721-2267 | |
(231) 597-8192 | |
(231) 597-8463 |
Full Name | |
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Speciality | Clinic/Center |
Location | 920 S Huron St, Cheboygan, Michigan |
Authorized Official Name and Position | Sonja Sprague (CREDENTIALING AND ENROLLMENTS) |
Authorized Official Contact | 9066430451 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1140 N State St Saint Ignace MI 49781-1048 Ph: () - | 920 S Huron St Cheboygan MI 49721-2267 Ph: (231) 597-8192 |
NPI Number | 1659868206 |
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Provider Enumeration Date | 04/19/2018 |
Last Update Date | 01/27/2025 |
Medicare PECOS PAC ID | 1456420876 |
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Medicare Enrollment ID | O20181004002034 |
Identifier | Type | State | Issuer |
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1659868206 | NPI | - | NPPES |
238716 | Other | MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (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 | |