GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS; NPI #1508126517

Contact Information

GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS

2300 N STALLMAN ROAD
PESHAWBESTOWN, MI 49682

Phone: 231-534-7211
Fax: 231-534-7460
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Dental	261QD0000X

Indicates primary specialty

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NPI Profile & details for GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS

NPI Number 1508126517

LBN Legal business name GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS

Authorized official LORI CHAMBERS - (MANAGER)

Entity Organization

Organization subpart ¹ No

Enumeration date 05/23/2012

Last updated 12/04/2013 - About 13 years ago

Identifiers

License #

261QD0000X

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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