Provider Demographics
NPI:1205805181
Name:DISTRICT HEALTH DEPARTMENT NO. 2
Entity type:Organization
Organization Name:DISTRICT HEALTH DEPARTMENT NO. 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:BAS
Authorized Official - Phone:989-343-1800
Mailing Address - Street 1:630 PROGRESS ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-8603
Mailing Address - Country:US
Mailing Address - Phone:989-345-5020
Mailing Address - Fax:989-343-1899
Practice Address - Street 1:630 PROGRESS ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-8603
Practice Address - Country:US
Practice Address - Phone:989-345-5020
Practice Address - Fax:989-343-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0000009251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4318627OtherMOLINA FAMILY PLANNING
MI4318627OtherMCLAREN - FP
MI232675845Medicaid
MI235101220Medicaid
MI235101258Medicaid
MI5008766930OtherBCBS FP/WHC/IMMS
MI235101267Medicaid
MI=========052OtherCC FAMILY PLANNING
MI232675845Medicaid