Provider Demographics
NPI:1619397049
Name:VAN BUREN/CASS DISTRICT PUBLIC HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:VAN BUREN/CASS DISTRICT PUBLIC HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-621-3143
Mailing Address - Street 1:302 SOUTH FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-1762
Mailing Address - Country:US
Mailing Address - Phone:269-782-0064
Mailing Address - Fax:269-785-0235
Practice Address - Street 1:302 SOUTH FRONT STREET
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-1762
Practice Address - Country:US
Practice Address - Phone:269-782-0064
Practice Address - Fax:269-785-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty