Provider Demographics
NPI:1205363207
Name:OAKLAND INTEGRATED HEALTHCARE NETWORK
Entity Type:Organization
Organization Name:OAKLAND INTEGRATED HEALTHCARE NETWORK
Other - Org Name:PONTIAC MIDDLE SCHOOL-TEEN HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-281-7149
Mailing Address - Street 1:PO BOX 430150
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48343-0150
Mailing Address - Country:US
Mailing Address - Phone:248-724-7434
Mailing Address - Fax:
Practice Address - Street 1:1275 N PERRY ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-3135
Practice Address - Country:US
Practice Address - Phone:248-857-7432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)