Provider Demographics
NPI:1568408128
Name:COUNTY OF BAY
Entity Type:Organization
Organization Name:COUNTY OF BAY
Other - Org Name:BAY COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:HICKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-895-4130
Mailing Address - Street 1:515 CENTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708
Mailing Address - Country:US
Mailing Address - Phone:989-895-4130
Mailing Address - Fax:989-895-2094
Practice Address - Street 1:1200 WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708
Practice Address - Country:US
Practice Address - Phone:989-895-2018
Practice Address - Fax:989-895-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or LocalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI77-1851151Medicaid
MI77-2978235Medicaid
MI1008322OtherMCLAREN HEALTH PLANS
MI142861OtherGREAT LAKES HEALTH PLANS
MI69-0Z915100OtherBCBS, BCN
MIM031678OtherCHAMPUS
MI77-2978244Medicaid
MI23-5100045Medicaid
MI6H110011OtherHEALTH PLUS OF MICHIGAN
MI1003763OtherMCLAREN HEALTH ADVANTAGE
MI16-4250843Medicaid
MI28869OtherCOMMUNITY CHOICE
MIQMXPR0012379OtherMOLINA
MI1008322OtherMCLAREN HEALTH PLANS