Provider Demographics
NPI:1376859173
Name:MID-MICHIGAN DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MID-MICHIGAN DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-831-3641
Mailing Address - Street 1:615 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48888-9702
Mailing Address - Country:US
Mailing Address - Phone:989-831-5237
Mailing Address - Fax:989-831-5522
Practice Address - Street 1:615 N STATE ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9702
Practice Address - Country:US
Practice Address - Phone:989-831-5237
Practice Address - Fax:989-831-3666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223D0001X, 1223G0001X, 2083P0901X
MI2901011007251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901018840OtherDENTAL