Provider Demographics
NPI:1245561620
Name:ST CLAIR COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:ST CLAIR COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCATANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-987-9396
Mailing Address - Street 1:3415 28TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6931
Mailing Address - Country:US
Mailing Address - Phone:810-987-9396
Mailing Address - Fax:810-985-2150
Practice Address - Street 1:3415 28TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6931
Practice Address - Country:US
Practice Address - Phone:810-987-9396
Practice Address - Fax:810-985-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI77-1905931Medicaid
MI77-5253868Medicaid
MI77-5259585Medicaid