Provider Demographics
NPI:1790830966
Name:BARRY-EATON DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:BARRY-EATON DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-541-2673
Mailing Address - Street 1:1033 HEALTHCARE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1058
Mailing Address - Country:US
Mailing Address - Phone:517-541-2673
Mailing Address - Fax:517-543-2656
Practice Address - Street 1:330 W WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1035
Practice Address - Country:US
Practice Address - Phone:517-541-2673
Practice Address - Fax:517-543-2656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5100027Medicaid
MIP00297302OtherRR RETIREMENT MASS IMMUNI
MI1845717Medicaid
MI5100027Medicaid
MION97350Medicare ID - Type UnspecifiedGROUP