Provider Demographics
NPI:1508868662
Name:ISABELLA COUNTY MEDICAL CARE
Entity Type:Organization
Organization Name:ISABELLA COUNTY MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NETANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-772-2957
Mailing Address - Street 1:1222 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3200
Mailing Address - Country:US
Mailing Address - Phone:989-772-2957
Mailing Address - Fax:989-772-3669
Practice Address - Street 1:1222 NORTH DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3200
Practice Address - Country:US
Practice Address - Phone:989-772-2957
Practice Address - Fax:989-772-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI378510314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4952800Medicaid
MI09634OtherBLUE CROSS OF MICHIGAN
MI4952800Medicaid