Provider Demographics
NPI: | 1790339406 |
---|---|
Name: | ISABELLA CITIZENS FOR HEALTH, INC. |
Entity Type: | Organization |
Organization Name: | ISABELLA CITIZENS FOR HEALTH, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | BILLING/REVENUE CYCLE COORDINATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LYDIA |
Authorized Official - Middle Name: | ROSE |
Authorized Official - Last Name: | STEVENS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 989-779-5642 |
Mailing Address - Street 1: | 2790 HEALTH PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | MT PLEASANT |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48858-9342 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 989-953-5320 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 400 WEBSTER ST |
Practice Address - Street 2: | |
Practice Address - City: | ITHACA |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48847-1818 |
Practice Address - Country: | US |
Practice Address - Phone: | 989-953-5320 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ISABELLA CITIZENS FOR HEALTH, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2019-07-31 |
Last Update Date: | 2020-01-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty |