Provider Demographics
NPI:1780692400
Name:JACKSON COUNTY
Entity type:Organization
Organization Name:JACKSON COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:RASHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-768-1658
Mailing Address - Street 1:1715 LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2193
Mailing Address - Country:US
Mailing Address - Phone:517-788-4420
Mailing Address - Fax:517-788-4373
Practice Address - Street 1:1715 LANSING AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2193
Practice Address - Country:US
Practice Address - Phone:517-788-4420
Practice Address - Fax:517-788-4373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF JACKSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-05
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI868OtherHEALTH PLAN OF MICHIGAN
MI4300OtherGREAT LAKES HEALTH PLAN
MI77 279528Medicaid
MI77 4411612Medicaid
MI85OtherHEALTH PLAN OF MICHIGAN
MI1339OtherHEALTH PLAN OF MICHIGAN
MI77 1850332Medicaid
MI77 4411621Medicaid
MI895OtherGREAT LAKES HEALTH PLAN
MI23 5100475Medicaid
MI77 3144336Medicaid
MI1330OtherHEALTH PLAN OF MICHIGAN
MI77 3363548Medicaid
MI77 4387900Medicaid
MIOC8100OtherBLUE CARE NETWORK OF MI
MI15 5173678Medicaid
MI23 5100475Medicaid
MI77 3363548Medicaid