Healthcare Provider Details

I. General information

NPI: 1528843422
Provider Name (Legal Business Name): ISABELLA CITIZENS FOR HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SOUTH DR STE 220
MT PLEASANT MI
48858-3255
US

IV. Provider business mailing address

2790 HEALTH PKWY
MOUNT PLEASANT MI
48858-6934
US

V. Phone/Fax

Practice location:
  • Phone: 989-773-3411
  • Fax:
Mailing address:
  • Phone: 989-779-5462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNN WHITE
Title or Position: CEO
Credential:
Phone: 989-953-5191