1740391523 NPI number — COUNTY OF KALAMAZOO

Table of content: (NPI 1740391523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740391523 NPI number — COUNTY OF KALAMAZOO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF KALAMAZOO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KALAMAZOO COUNTY HEALTH & COMMUNITY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740391523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 42
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAZARETH
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49074-0042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-373-5200
Provider Business Mailing Address Fax Number:
269-373-5363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3299 GULL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49048-1281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-373-5259
Provider Business Practice Location Address Fax Number:
269-373-5292
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOMNICK
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
269-373-5200

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 744571714 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: OP390039 . This is a "M-CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00055287 . This is a "MEDICARE RR PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0C90266 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1103300800 . This is a "MEDICARE RR PCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 164490661 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6004860 . This is a "MOLINA HEALTHCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 771860393 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 235100484 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88138 . This is a "DELTA DENTAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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