Healthcare Provider Details

I. General information

NPI: 1033201348
Provider Name (Legal Business Name): VAN BUREN-CASS COUNTY DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57418 COUNTY ROAD 681 SUITE A
HARTFORD MI
49057-9421
US

IV. Provider business mailing address

57418 COUNTY ROAD 681 SUITE A
HARTFORD MI
49057-9421
US

V. Phone/Fax

Practice location:
  • Phone: 269-621-3143
  • Fax: 269-621-2725
Mailing address:
  • Phone: 269-621-3143
  • Fax: 269-621-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFERY L ELLIOTT
Title or Position: HEALTH OFFICER/ADMINISTRATOR
Credential:
Phone: 269-621-3143