Provider Demographics
NPI:1265441877
Name:DISTRICT HEALTH DEPARTMENT NO 10
Entity Type:Organization
Organization Name:DISTRICT HEALTH DEPARTMENT NO 10
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATIVE SERVICES DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-689-7300
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:WHITE CLOUD
Mailing Address - State:MI
Mailing Address - Zip Code:49349-0850
Mailing Address - Country:US
Mailing Address - Phone:231-689-7300
Mailing Address - Fax:231-689-7360
Practice Address - Street 1:1049 E NEWELL ST
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-8795
Practice Address - Country:US
Practice Address - Phone:231-689-7300
Practice Address - Fax:231-689-7360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI235100644Medicaid
MI234820462Medicaid
MI235101196Medicaid
MI235100653Medicaid
MI774636480Medicaid
MI235101187Medicaid
MI235101211Medicaid
MI235101202Medicaid
MI771850388Medicaid
MI235101187Medicaid