Provider Demographics
NPI:1568560308
Name:COUNTY OF INGHAM
Entity Type:Organization
Organization Name:COUNTY OF INGHAM
Other - Org Name:CEDAR COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY HEALTH OFFICER/EXE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-887-4361
Mailing Address - Street 1:PO BOX 30161
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-7661
Mailing Address - Country:US
Mailing Address - Phone:517-887-4311
Mailing Address - Fax:517-887-4310
Practice Address - Street 1:5303 S CEDAR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-3800
Practice Address - Country:US
Practice Address - Phone:517-887-4311
Practice Address - Fax:517-887-4310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF INGHAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
03C6051OtherBCBS PIN
C310850OtherBCBS PIN
MI231894Medicare Oscar/Certification
C310850OtherBCBS PIN
MI0C36051Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
MI0N80630Medicare PIN