1669497053 NPI number — COUNTY OF TUSCOLA HEALTH DEPT.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669497053 NPI number — COUNTY OF TUSCOLA HEALTH DEPT.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF TUSCOLA HEALTH DEPT.
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:
1669497053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1309 CLEAVER RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CARO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48723-9160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-673-8114
Provider Business Mailing Address Fax Number:
989-673-7490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1309 CLEAVER RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CARO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48723-9160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-673-8114
Provider Business Practice Location Address Fax Number:
989-673-7490
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TENBUSCH
Authorized Official First Name:
GRETCHEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
HEALTH OFFICER
Authorized Official Telephone Number:
989-673-8114

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  5101005982 , 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: 235100976 . This is a "HEALTH PLAN OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2676468 . This is a "MOLINA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5100976 . This is a "MOLINA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 771897956 . This is a "HEALTH PLAN OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 771897956 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0984564 . This is a "HEALTH PLUS OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000777 . This is a "HEALTH ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700G96012 . This is a "BCBSM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1897956 . This is a "MOLINA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 235100976 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118756 . This is a "GREAT LAKES HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5008706080 . This is a "BCBSM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700G960120 . This is a "BLUE CARE NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000777 . This is a "MCLAREN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 772676468 . This is a "HEALTH PLAN OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 772676468 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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