Provider Demographics
NPI:1760443584
Name:DISTRICT HEALTH DEPARTMENT NO. 4
Entity Type:Organization
Organization Name:DISTRICT HEALTH DEPARTMENT NO. 4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-356-4507
Mailing Address - Street 1:100 WOODS CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1444
Mailing Address - Country:US
Mailing Address - Phone:989-356-4507
Mailing Address - Fax:989-358-7997
Practice Address - Street 1:100 WOODS CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1444
Practice Address - Country:US
Practice Address - Phone:989-356-4507
Practice Address - Fax:989-358-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E041OtherBC/BS OF MICHIGAN
MI5008767580OtherBCBS - THOMPSON
MI5101374Medicaid
MI4357447Medicaid
MI4357465Medicaid
MI1012525-0001OtherWELLNESS PLAN
MI5173865Medicaid
MI4357438Medicaid
MI5008768130OtherBCBS - MINK
MI5008752000OtherBCBS - MILLER
MI1850360Medicaid
MI4357429Medicaid
MI4357447Medicaid
MI=========050OtherCOMMUNITY CHOICE - IMM
MI4357429Medicaid
MI5008767580OtherBCBS - THOMPSON
MI5008768130OtherBCBS - MINK
MI=========053OtherCOMMUNITY CHOICE - FP
MI4357429Medicaid
MI1850360Medicaid