1376546366 NPI number — COUNTY OF BAY

Table of content: (NPI 1376546366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376546366 NPI number — COUNTY OF BAY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF BAY
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:
BAY COUNTY MEDICAL CARE FACILITY
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:
1376546366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
564 W HAMPTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESSEXVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48732-9710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-892-3591
Provider Business Mailing Address Fax Number:
989-892-6991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
564 W HAMPTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESSEXVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48732-9710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-892-3591
Provider Business Practice Location Address Fax Number:
989-892-6991
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MACALPINE
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
989-892-3591

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  098510 , 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: 09567 . This is a "BCBS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2085123 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 690353780 . This is a "STATE I.D." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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