| Northern Michigan Substance Abuse Services, Inc. | |
|
2136 W M 32 Gaylord MI 49735-9282 | |
| (989) 732-1791 | |
| (989) 732-7052 |
| Full Name | Northern Michigan Substance Abuse Services, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2136 W M 32, Gaylord, Michigan |
| Authorized Official Name and Position | Sue Winter (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9897321791 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Michigan Substance Abuse Services, Inc. 2136 W M 32 Gaylord MI 49735-9282 Ph: (989) 732-1791 | Northern Michigan Substance Abuse Services, Inc. 2136 W M 32 Gaylord MI 49735-9282 Ph: (989) 732-1791 |
| NPI Number | 1164641676 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 10/27/2014 |
| Medicare PECOS PAC ID | 3971818998 |
|---|---|
| Medicare Enrollment ID | O20150819007821 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164641676 | NPI | - | NPPES |
| 174458207 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | SA0690031 (Michigan) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | 690031 (Michigan) | Primary |
| Provider Name | Frank A Weber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174663736 PECOS PAC ID: 8628172145 Enrollment ID: I20070322000333 |
| Provider Name | Eugene P Wang |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1922063908 PECOS PAC ID: 2466548078 Enrollment ID: I20071012000141 |
| Provider Name | Julia Anne Riddle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275785578 PECOS PAC ID: 0244363224 Enrollment ID: I20100727000938 |
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