Provider Demographics
NPI:1700072329
Name:ST CLAIR COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:ST CLAIR COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:810-987-9396
Mailing Address - Street 1:3415 28TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6931
Mailing Address - Country:US
Mailing Address - Phone:810-987-9396
Mailing Address - Fax:810-985-2150
Practice Address - Street 1:3415 28TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6931
Practice Address - Country:US
Practice Address - Phone:810-987-9396
Practice Address - Fax:810-985-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4046170Medicaid
MI=========OtherDELTA DENTAL