1750474839 NPI number — COUNTY OF CALHOU

Table of content: (NPI 1750474839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750474839 NPI number — COUNTY OF CALHOU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF CALHOU
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:
STUDENT HEALTH CENTER
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:
1750474839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 E MICHIGAN AVE STE A100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49014-4019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-969-6376
Provider Business Mailing Address Fax Number:
269-966-1489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 VAN BUREN ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49017-3050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-965-9539
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOWERSOX
Authorized Official First Name:
DOTTIE KAY
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH OFFICER
Authorized Official Telephone Number:
269-969-6376

Provider Taxonomy Codes

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

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

  • Identifier: 4583054 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".