1053478222 NPI number — COUNTY OF CALHOUN

Table of content: (NPI 1053478222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053478222 NPI number — COUNTY OF CALHOUN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF CALHOUN
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:
1053478222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 E MICHIGAN AVE
Provider Second Line Business Mailing Address:
SUITE A100
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49014-4005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-969-6376
Provider Business Mailing Address Fax Number:
269-966-1489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 W GREEN ST
Provider Second Line Business Practice Location Address:
SUITE 1-600
Provider Business Practice Location Address City Name:
MARSHALL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49068-1518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-781-0909
Provider Business Practice Location Address Fax Number:
269-781-0958
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOWERSOX
Authorized Official First Name:
DOTTIE
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
HEALTH OFFICER
Authorized Official Telephone Number:
269-969-6380

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)

  • Identifier: 4281652 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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