Provider Demographics
NPI:1346468386
Name:CITY OF DETROIT
Entity Type:Organization
Organization Name:CITY OF DETROIT
Other - Org Name:DEPARTMENT OF HEALTH AND WELLNESS PROMOTION, HKFHC- FAMILY PLANNING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MSN
Authorized Official - Phone:313-876-4301
Mailing Address - Street 1:1151 TAYLOR ST 349
Mailing Address - Street 2:DETROIT HEALTH DEPART - HERMAN KIEFER HEALTH COMPLEX
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1732
Mailing Address - Country:US
Mailing Address - Phone:313-876-4710
Mailing Address - Fax:313-876-0177
Practice Address - Street 1:1151 TAYLOR ST
Practice Address - Street 2:DETROIT HEALTH DEPART - HERMAN KIEFER HEALTH COMPLEX
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-4710
Practice Address - Fax:313-876-0177
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF DETROIT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-23
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010016981835P0018X
MI207KI0005X
MI261QA0005X261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning FacilityGroup - Multi-Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7006276Medicaid