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740 S Main St Stes 3a, 3b, 1d Cheboygan MI 49721-2220 | |
(231) 627-4364 | |
(231) 627-7758 |
Full Name | |
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Speciality | Clinic/Center |
Location | 740 S Main St, Cheboygan, Michigan |
Authorized Official Name and Position | Tara Soules (VP/CFO) |
Authorized Official Contact | 9897726818 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1221 South Dr Mt Pleasant MI 48858-3257 Ph: (989) 772-6700 | 740 S Main St Stes 3a, 3b, 1d Cheboygan MI 49721-2220 Ph: (231) 627-4364 |
NPI Number | 1982226015 |
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Provider Enumeration Date | 05/12/2020 |
Last Update Date | 02/11/2022 |
Medicare PECOS PAC ID | 6103733092 |
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Medicare Enrollment ID | O20200811000826 |
Identifier | Type | State | Issuer |
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1982226015 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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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 | |