| |
3147 Logan Valley Rd Traverse City MI 49684-4772 | |
(231) 935-0799 | |
(231) 935-0962 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 3147 Logan Valley Rd, Traverse City, Michigan |
Authorized Official Name and Position | Arlene J. Brennan (CEO) |
Authorized Official Contact | 2319350351 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
3155 Logan Valley Rd Traverse City MI 49684-4772 Ph: (231) 935-0799 | 3147 Logan Valley Rd Traverse City MI 49684-4772 Ph: (231) 935-0799 |
NPI Number | 1467632059 |
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Provider Enumeration Date | 11/12/2007 |
Last Update Date | 12/11/2015 |
Medicare PECOS PAC ID | 0547407181 |
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Medicare Enrollment ID | O20130520000057 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467632059 | NPI | - | NPPES |
1265517494 | Medicaid | MI | |
1972680411 | Medicaid | MI | |
1255702486 | Medicaid | MI | |
1437155488 | Medicaid | MI | |
1841296613 | Medicaid | MI | |
1760702161 | Medicaid | MI | |
1619196680 | Medicaid | MI | |
1669441457 | Medicaid | MI | |
1891994026 | Medicaid | MI | |
1730153149 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Lynn L Swan |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1972680411 PECOS PAC ID: 2365491222 Enrollment ID: I20050119000122 |
Provider Name | Roger K Gerstle |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1285792754 PECOS PAC ID: 3870693260 Enrollment ID: I20070713000768 |
Provider Name | David K Klee |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1497763809 PECOS PAC ID: 6709881600 Enrollment ID: I20090902000697 |
Provider Name | Marylee Pakieser |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1265517494 PECOS PAC ID: 7911995972 Enrollment ID: I20110113001084 |
Provider Name | Rachel E Soles |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033480769 PECOS PAC ID: 7012175003 Enrollment ID: I20120222000348 |
Provider Name | William C Fowle |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1154531648 PECOS PAC ID: 4880908607 Enrollment ID: I20150806010634 |
Provider Name | Jennifer Bowling |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1255702486 PECOS PAC ID: 6507176252 Enrollment ID: I20151109000734 |
Provider Name | Karen Lowe |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1386008654 PECOS PAC ID: 2466745104 Enrollment ID: I20160719000421 |
Provider Name | Amber Ristow |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1801361407 PECOS PAC ID: 9335483072 Enrollment ID: I20181206000458 |
Provider Name | Anna E Karolionok |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053931899 PECOS PAC ID: 4284058488 Enrollment ID: I20200701003454 |
Provider Name | Kelly K Ryan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1134675192 PECOS PAC ID: 6608156716 Enrollment ID: I20200715002313 |
Provider Name | Christine M Hawkins |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1275624462 PECOS PAC ID: 4981518487 Enrollment ID: I20211221002586 |
Provider Name | Natasha A Williams |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1215657333 PECOS PAC ID: 1254863889 Enrollment ID: I20241021001030 |
County Health Support Services Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 320 Washington St, Traverse City, MI 49684 Phone: 231-922-4532 | |
Northwest Michigan Health Services, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1776 3 Mile Rd N Rm 522, Traverse City, MI 49696 Phone: 231-642-9295 | |
Best Medical Services Plc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 814 S Garfield Ave Ste C, Traverse City, MI 49686 Phone: 231-922-8722 Fax: 231-486-6042 | |
Partners In Health Of Traverse City Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3074 N Us 31 S, Traverse City, MI 49684 Phone: 231-935-0535 Fax: 231-935-0454 | |
Indigo Hospital Medicine - Traverse City, Plc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1105 Sixth St, Traverse City, MI 49684 Phone: 231-346-6807 Fax: 231-346-6052 |