=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679802896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENESEE COUNTY HEALTH DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2009
-----------------------------------------------------
Last Update Date | 12/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | G3373 S SAGINAW ST BURTON HEALTH CENTER
-----------------------------------------------------
City | BURTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48529-1244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-237-4539
-----------------------------------------------------
Fax | 810-742-2561
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | G3373 S SAGINAW ST BURTON HEALTH CENTER
-----------------------------------------------------
City | BURTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48529-1244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-237-4539
-----------------------------------------------------
Fax | 810-742-2561
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. GARY KEITH JOHNSON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 810-257-3155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0050X
-----------------------------------------------------
Taxonomy Name | Non-Surgical Family Planning Clinic/Center
-----------------------------------------------------
License Number | 4704244015
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------