Provider Demographics
NPI:1235540501
Name:STEHOUWER FREE CLINIC
Entity type:Organization
Organization Name:STEHOUWER FREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-876-6152
Mailing Address - Street 1:201 N MITCHELL ST
Mailing Address - Street 2:L-1
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-1859
Mailing Address - Country:US
Mailing Address - Phone:231-876-6152
Mailing Address - Fax:231-779-9829
Practice Address - Street 1:201 N MITCHELL ST
Practice Address - Street 2:L-1
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1859
Practice Address - Country:US
Practice Address - Phone:231-876-6152
Practice Address - Fax:231-779-9829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D0996622261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health