Healthcare Provider Details

I. General information

NPI: 1053408948
Provider Name (Legal Business Name): COUNTY OF ST CLAIR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/20/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 FORT ST
PORT HURON MI
48060-3850
US

IV. Provider business mailing address

220 FORT ST
PORT HURON MI
48060-3850
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-5300
  • Fax: 810-985-2150
Mailing address:
  • Phone: 810-987-5300
  • Fax: 810-985-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2901011180
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberAM051181
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: GREG BROWN
Title or Position: ADMINISTRATOR
Credential:
Phone: 810-987-5300