1639132442 NPI number — COUNTY OF WASHTENAW

Table of content: (NPI 1639132442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639132442 NPI number — COUNTY OF WASHTENAW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF WASHTENAW
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:
1639132442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 TOWNER ST
Provider Second Line Business Mailing Address:
PO BOX 915
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48198-5752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-544-3015
Provider Business Mailing Address Fax Number:
734-544-6732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 TOWNER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48198-5752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-544-3000
Provider Business Practice Location Address Fax Number:
734-544-6732
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CORTES
Authorized Official First Name:
TRISH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
734-544-3000

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 750910468 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4965236 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com