Provider Demographics
NPI:1073032355
Name:JACKSON COUNTY
Entity Type:Organization
Organization Name:JACKSON COUNTY
Other - Org Name:JACKSON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:THOUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-768-1658
Mailing Address - Street 1:1715 LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2193
Mailing Address - Country:US
Mailing Address - Phone:517-788-4420
Mailing Address - Fax:517-788-4373
Practice Address - Street 1:1715 LANSING AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2193
Practice Address - Country:US
Practice Address - Phone:517-788-4420
Practice Address - Fax:517-788-4373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF JACKSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI77279528Medicaid