Provider Demographics
NPI:1497863229
Name:COUNTY OF SAGINAW
Entity Type:Organization
Organization Name:COUNTY OF SAGINAW
Other - Org Name:COUNTY OF SAGINAW, DEPT. OF PUBLIC HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCKELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:989-758-3818
Mailing Address - Street 1:111 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-2019
Mailing Address - Country:US
Mailing Address - Phone:989-758-3800
Mailing Address - Fax:989-758-3750
Practice Address - Street 1:1600 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5306
Practice Address - Country:US
Practice Address - Phone:989-758-3800
Practice Address - Fax:989-758-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006168251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1996883Medicaid
MI2911586Medicaid
MI5100840Medicaid
MI87726OtherPHYSICIANS HEALTH PLAN
MI18167OtherPRIORITY HEALTH
MI1849897Medicaid
MI0980306OtherHEALTH PLUS
MI1111H1OtherMOLINA HEALTH PLAN
MI7888OtherGREAT LAKES HEALTH PLAN
MI1111H1OtherMOLINA HEALTH PLAN
MI7888OtherGREAT LAKES HEALTH PLAN