1326042946 NPI number — COUNTY OF SHIAWASSEE

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 1326042946 NPI number — COUNTY OF SHIAWASSEE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SHIAWASSEE
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:
1326042946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 E MACK STREET
Provider Second Line Business Mailing Address:
ATTN: ADMINISTRATION
Provider Business Mailing Address City Name:
CORUNNA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48817-1440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-743-2318
Provider Business Mailing Address Fax Number:
989-743-2357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 E MACK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORUNNA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48817-1459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-743-2356
Provider Business Practice Location Address Fax Number:
989-743-2362
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PICHETTE
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
HEALTH OFFICER
Authorized Official Telephone Number:
989-743-2318

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , 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: 200000000547 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202916 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200000000548 . This is a "PHYSICIANS HEALTH PLAN IM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0982874 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200000000548 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0982874 . This is a "HEALTHPLUS COMMERCIAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 600G80600 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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