1669497053 NPI number — COUNTY OF TUSCOLA HEALTH DEPT.

Table of content: (NPI 1669497053)

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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