Provider Demographics
NPI:1558388082
Name:ALLEGAN COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:ALLEGAN COUNTY HEALTH DEPARTMENT
Other - Org Name:MATERNAL INFANT HEALTH PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-673-5411
Mailing Address - Street 1:3255 122ND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9511
Mailing Address - Country:US
Mailing Address - Phone:269-673-5411
Mailing Address - Fax:269-673-4172
Practice Address - Street 1:3255 122ND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9511
Practice Address - Country:US
Practice Address - Phone:269-673-5411
Practice Address - Fax:269-673-4172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF ALLEGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1184627135OtherNPI NUMBER (OTHER)
MI1849707Medicaid