1568408128 NPI number — COUNTY OF BAY

Table of content: (NPI 1568408128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568408128 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 HEALTH DEPARTMENT
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:
1568408128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 CENTER AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-895-4130
Provider Business Mailing Address Fax Number:
989-895-2094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 WASHINGTON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-895-2018
Provider Business Practice Location Address Fax Number:
989-895-4014
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HICKNER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
L
Authorized Official Title or Position:
COUNTY EXECUTIVE
Authorized Official Telephone Number:
989-895-4130

Provider Taxonomy Codes

  • Taxonomy code: 2083P0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 77-1851151 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 77-2978235 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1008322 . This is a "MCLAREN HEALTH PLANS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 142861 . This is a "GREAT LAKES HEALTH PLANS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 69-0Z915100 . This is a "BCBS, BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: M031678 . This is a "CHAMPUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 77-2978244 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23-5100045 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6H110011 . This is a "HEALTH PLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1003763 . This is a "MCLAREN HEALTH ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 16-4250843 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28869 . This is a "COMMUNITY CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: QMXPR0012379 . This is a "MOLINA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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