Provider Demographics
NPI:1629250790
Name:DISTRICT HEALTH DEPARTMENT NO. 2
Entity Type:Organization
Organization Name:DISTRICT HEALTH DEPARTMENT NO. 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-343-1800
Mailing Address - Street 1:630 PROGRESS ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-8603
Mailing Address - Country:US
Mailing Address - Phone:989-345-5020
Mailing Address - Fax:
Practice Address - Street 1:630 PROGRESS ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-8603
Practice Address - Country:US
Practice Address - Phone:989-345-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0000009251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1927026OtherMOLINA MSSISS - IOSCO
MI1927062OtherMOLINA MSSISS - OSCODA
MI1927044OtherMOLINA MSSISS - OGEMAW
MI1927008OtherMOLINA MSSISS - ALCONA
MI38191267053OtherCOMMUNITY CHOICE MSSISS