Provider Demographics
NPI:1184627135
Name:ALLEGAN COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:ALLEGAN COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-673-5411
Mailing Address - Street 1:3255 122ND AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9511
Mailing Address - Country:US
Mailing Address - Phone:269-267-5411
Mailing Address - Fax:269-673-4172
Practice Address - Street 1:3255 122ND AVE
Practice Address - Street 2:STE 200
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9511
Practice Address - Country:US
Practice Address - Phone:269-267-5411
Practice Address - Fax:269-673-4172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF ALLEGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1849707OtherMOLINA
MI4301044487OtherPRIORITY HEALTH
MI774208868Medicaid
MI3900300102OtherBCBS OF MI
MI771849707Medicaid
MI13556OtherHEALTH PLAN OF MI
MI13556OtherHEALTH PLAN OF MI
MI1849707OtherMOLINA
MI4301044487OtherPRIORITY HEALTH
MI13556OtherHEALTH PLAN OF MI