LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS NPI 1124052816

NPI Information

  • NPI: 1124052816
  • Provider Name: LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS
  • Classification: Clinic/Center - 261QF0400X
  • Specialization: Federally Qualified Health Center (FQHC)
  • Entity Type: Organization
  • Address: 1260 AJIJAAK AVE
    PETOSKEY, MI
    ZIP 49770
  • Phone: (231) 242-1700

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NPI Details

LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS is a federally qualified health center (fqhc) clinic center in Petoskey, MI. LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS NPI is 1124052816. The provider is registered as an organization entity type.

The provider's business location address is:

1260 AJIJAAK AVE
PETOSKEY, MI
ZIP 49770-330
Phone: (231) 242-1700
Fax: (231) 242-1717

The provider's authorized official is Christina Dubois .
The authorized official title is Assistant Health Director and has the following contact phone number (231) 242-1611.

The enumeration date for this NPI number is 7/10/2006 and was last updated on 5/20/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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