1679120810 NPI number — COUNTY OF INGHAM

Table of content: (NPI 1679120810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679120810 NPI number — COUNTY OF INGHAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF INGHAM
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:
EVERETT ICHD
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:
1679120810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30161
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48909-7661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-887-4467
Provider Business Mailing Address Fax Number:
517-244-7174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 STABLER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48910-4567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-244-8060
Provider Business Practice Location Address Fax Number:
517-244-7180
Provider Enumeration Date:
08/22/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DRAKE
Authorized Official First Name:
KRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
DHO / ED
Authorized Official Telephone Number:
517-887-4361

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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