Healthcare Provider Details

I. General information

NPI: 1568408128
Provider Name (Legal Business Name): COUNTY OF BAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WASHINGTON AVENUE
BAY CITY MI
48708
US

IV. Provider business mailing address

515 CENTER AVENUE
BAY CITY MI
48708
US

V. Phone/Fax

Practice location:
  • Phone: 989-895-2018
  • Fax: 989-895-4014
Mailing address:
  • Phone: 989-895-4130
  • Fax: 989-895-2094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS L HICKNER
Title or Position: COUNTY EXECUTIVE
Credential:
Phone: 989-895-4130