1184627135 NPI number — ALLEGAN COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1184627135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184627135 NPI number — ALLEGAN COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEGAN COUNTY HEALTH DEPARTMENT
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:
Provider Other Organization Name Type Code:
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:
1184627135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3255 122ND AVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
ALLEGAN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49010-9511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-267-5411
Provider Business Mailing Address Fax Number:
269-673-4172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3255 122ND AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
ALLEGAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49010-9511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-267-5411
Provider Business Practice Location Address Fax Number:
269-673-4172
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TOOKER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
269-673-5411

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: 1849707 . This is a "MOLINA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4301044487 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 774208868 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3900300102 . This is a "BCBS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 771849707 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13556 . This is a "HEALTH PLAN OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com