1891823175 NPI number — COUNTY OF HOUGHTON

Table of content: (NPI 1891823175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891823175 NPI number — COUNTY OF HOUGHTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF HOUGHTON
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:
WESTERN U.P. DISTRICT HEALTH DEPARTMENT & SUPERIOR HOME NURSING & HOSP
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:
1891823175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 DEPOT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANCOCK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49930-2031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-482-7382
Provider Business Mailing Address Fax Number:
906-482-9410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 COPPER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONTONAGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49953-1158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-884-4485
Provider Business Practice Location Address Fax Number:
906-884-2358
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEER
Authorized Official First Name:
CATHRYN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
HEALTH OFFICER
Authorized Official Telephone Number:
906-482-7382

Provider Taxonomy Codes

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

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

  • Identifier: 773018690 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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