Provider Demographics
NPI:1407828080
Name:BEAVER ISLAND RURAL HEALTH CENTER
Entity type:Organization
Organization Name:BEAVER ISLAND RURAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-448-2275
Mailing Address - Street 1:37304 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BEAVER ISLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49782-9792
Mailing Address - Country:US
Mailing Address - Phone:231-448-2275
Mailing Address - Fax:231-448-2348
Practice Address - Street 1:37304 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BEAVER ISLAND
Practice Address - State:MI
Practice Address - Zip Code:49782-9792
Practice Address - Country:US
Practice Address - Phone:231-448-2275
Practice Address - Fax:231-448-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1407828080Medicaid
MIOP18960Medicare ID - Type Unspecified
MI1407828080Medicaid