Provider Demographics
NPI:1013299130
Name:COUNTY OF INGHAM
Entity Type:Organization
Organization Name:COUNTY OF INGHAM
Other - Org Name:WELL CHILD HEALTH CENTER OF INGHAM COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DHO / ED
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-887-4361
Mailing Address - Street 1:PO BOX 30161
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-7661
Mailing Address - Country:US
Mailing Address - Phone:517-887-4467
Mailing Address - Fax:517-244-7174
Practice Address - Street 1:901 E MOUNT HOPE AVE
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3279
Practice Address - Country:US
Practice Address - Phone:517-267-3400
Practice Address - Fax:517-372-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
231948Medicare Oscar/Certification
MIOM77560Medicare PIN
MIOC36051Medicare PIN