Provider Demographics
NPI:1255419214
Name:COUNTY OF BENZIE
Entity type:Organization
Organization Name:COUNTY OF BENZIE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNTY SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-882-0553
Mailing Address - Street 1:448 COURT PLACE
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:MI
Mailing Address - Zip Code:49617-9518
Mailing Address - Country:US
Mailing Address - Phone:231-882-0625
Mailing Address - Fax:231-882-0033
Practice Address - Street 1:448 COURT PL
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:MI
Practice Address - Zip Code:49617-9518
Practice Address - Country:US
Practice Address - Phone:231-882-0625
Practice Address - Fax:231-882-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1010013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3003187Medicaid
MI590A000030OtherBLUE CROSS BLUE SHIELD
MI590058442OtherRAILROAD MEDICARE
MI590058442OtherRAILROAD MEDICARE