Provider Demographics
NPI:1396843041
Name:DICKINSON-IRON DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:DICKINSON-IRON DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-265-4196
Mailing Address - Street 1:1374 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL FALLS
Mailing Address - State:MI
Mailing Address - Zip Code:49920-1085
Mailing Address - Country:US
Mailing Address - Phone:906-265-9913
Mailing Address - Fax:906-874-2950
Practice Address - Street 1:1374 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL FALLS
Practice Address - State:MI
Practice Address - Zip Code:49920-1085
Practice Address - Country:US
Practice Address - Phone:906-265-9913
Practice Address - Fax:906-874-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI233025415Medicaid
MI773026299Medicaid
MI773026341Medicaid
MI233025424Medicaid
MI600C610040OtherBCBS OF MI