Provider Demographics
NPI:1407490006
Name:OAKLAND INTEGRATED HEALTHCARE NETWORK
Entity Type:Organization
Organization Name:OAKLAND INTEGRATED HEALTHCARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-724-7413
Mailing Address - Street 1:PO BOX 430150
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48343-0150
Mailing Address - Country:US
Mailing Address - Phone:248-724-7600
Mailing Address - Fax:248-724-7447
Practice Address - Street 1:3825 W WALTON BLVD
Practice Address - Street 2:ROOM B
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4270
Practice Address - Country:US
Practice Address - Phone:248-724-7600
Practice Address - Fax:248-724-7447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKLAND INTEGRATED HEALTHCARE NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health