1295741551 NPI number — COUNTY OF MIDLAND

Table of content: TONYA MITCHAM HUDSON FNP, BC (NPI 1962476788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295741551 NPI number — COUNTY OF MIDLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF MIDLAND
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:
6
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:
1295741551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 W ELLSWORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-832-6380
Provider Business Mailing Address Fax Number:
989-832-6628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 W ELLSWORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-832-6380
Provider Business Practice Location Address Fax Number:
989-832-6628
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRECEK
Authorized Official First Name:
C
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
HEALTH OFFICER
Authorized Official Telephone Number:
989-837-6574

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X , 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: 5100706 . This is a "MEDICAID FAMILY PLANNING" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 772842380 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0992312 . This is a "HEALTH PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 235100706 . This is a "MEDICARE FAMILY PLANNING" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1849725 . This is a "MEDICAID MIHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2842380 . This is a "MEDICAID IMMUNIZATION" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 771849725 . This is a "MEDICAID MSS ISS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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