Provider Demographics
NPI:1295741551
Name:COUNTY OF MIDLAND
Entity type:Organization
Organization Name:COUNTY OF MIDLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:C
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KRECEK
Authorized Official - Suffix:
Authorized Official - Credentials:RS MA
Authorized Official - Phone:989-837-6574
Mailing Address - Street 1:220 W ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-832-6380
Mailing Address - Fax:989-832-6628
Practice Address - Street 1:220 W ELLSWORTH ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-832-6380
Practice Address - Fax:989-832-6628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5100706OtherMEDICAID FAMILY PLANNING
MI772842380Medicaid
MI0992312OtherHEALTH PLUS
MI235100706OtherMEDICARE FAMILY PLANNING
MI1849725OtherMEDICAID MIHP
MI2842380OtherMEDICAID IMMUNIZATION
MI771849725OtherMEDICAID MSS ISS
MI0E61006Medicare ID - Type Unspecified