Provider Demographics
NPI:1033201348
Name:VAN BUREN-CASS COUNTY DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:VAN BUREN-CASS COUNTY DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-621-3143
Mailing Address - Street 1:57418 COUNTY ROAD 681
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARTFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49057-9421
Mailing Address - Country:US
Mailing Address - Phone:269-621-3143
Mailing Address - Fax:269-621-2725
Practice Address - Street 1:57418 COUNTY ROAD 681
Practice Address - Street 2:SUITE A
Practice Address - City:HARTFORD
Practice Address - State:MI
Practice Address - Zip Code:49057-9421
Practice Address - Country:US
Practice Address - Phone:269-621-3143
Practice Address - Fax:269-621-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4977193Medicaid
MI4419826Medicaid
MI4283853Medicaid