Provider Demographics
NPI:1932116191
Name:NORTHWEST MICHIGAN COMMUNITY HEALTH AGENCY
Entity Type:Organization
Organization Name:NORTHWEST MICHIGAN COMMUNITY HEALTH AGENCY
Other - Org Name:HEALTH DEPARTMENT OF NORTHWEST MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PEACOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-547-6523
Mailing Address - Street 1:220 W GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1631
Mailing Address - Country:US
Mailing Address - Phone:231-547-6523
Mailing Address - Fax:231-547-6238
Practice Address - Street 1:220 W GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1631
Practice Address - Country:US
Practice Address - Phone:231-547-6523
Practice Address - Fax:231-547-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251K00000X
261QF0050X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500A510100OtherBCBSM
MI4443643Medicaid
MI4443643Medicaid