1326005109 NPI number — COUNTY OF BERRIEN MICHIGAN

Table of content: (NPI 1326005109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326005109 NPI number — COUNTY OF BERRIEN MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF BERRIEN MICHIGAN
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:
BERRIEN COUNTY HEALTH DEPARTMENT
Provider Other Organization Name Type Code:
5
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:
1326005109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2149 EAST NAPIER AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENTON HARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-926-7121
Provider Business Mailing Address Fax Number:
269-926-8149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2149 EAST NAPIER AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTON HARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-926-7121
Provider Business Practice Location Address Fax Number:
269-926-8129
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
GUY
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH OFFICER
Authorized Official Telephone Number:
269-927-5639

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  4301038022 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QF0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 235100054 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 311882425 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 773520659 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 774478021 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 775057169 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 235100063 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 774077800 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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