Provider Demographics
NPI:1649368457
Name:SAGINAW CHIPPEWA INDIAN TRIBE
Entity type:Organization
Organization Name:SAGINAW CHIPPEWA INDIAN TRIBE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-775-4631
Mailing Address - Street 1:2591 SOUTH LEATON RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-775-4600
Mailing Address - Fax:989-775-4946
Practice Address - Street 1:2591 SOUTH LEATON RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-775-4600
Practice Address - Fax:989-775-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G05822OtherBCN GROUP
010C760120OtherBCBS GROUP
500C776040OtherBCBS GROUP
0C76012Medicare ID - Type UnspecifiedGROUP