Provider Demographics
NPI:1326042946
Name:COUNTY OF SHIAWASSEE
Entity Type:Organization
Organization Name:COUNTY OF SHIAWASSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PICHETTE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:989-743-2318
Mailing Address - Street 1:110 E MACK STREET
Mailing Address - Street 2:ATTN: ADMINISTRATION
Mailing Address - City:CORUNNA
Mailing Address - State:MI
Mailing Address - Zip Code:48817-1440
Mailing Address - Country:US
Mailing Address - Phone:989-743-2318
Mailing Address - Fax:989-743-2357
Practice Address - Street 1:110 E MACK ST
Practice Address - Street 2:
Practice Address - City:CORUNNA
Practice Address - State:MI
Practice Address - Zip Code:48817-1459
Practice Address - Country:US
Practice Address - Phone:989-743-2356
Practice Address - Fax:989-743-2362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000000547Medicaid
MI202916Medicaid
MI200000000548OtherPHYSICIANS HEALTH PLAN IM
MI0982874Medicaid
MI200000000548Medicaid
MI0982874OtherHEALTHPLUS COMMERCIAL
MI600G80600OtherBCBSM
MI200000000548Medicaid