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General NPI Number Information
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NPI Number | 1861675530
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Entity Type | Organization
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Legal Business Name | COUNTY OF KALAMAZOO
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 3299 GULL RD
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City | KALAMAZOO
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State | MI
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Zip | 49048-1281
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Country | US
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Telephone | 269-373-5360
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Fax | 269-373-5022
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Provider Business Mailing Address
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Address Line | PO BOX 42
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City | NAZARETH
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State | MI
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Zip | 49074-0042
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Country | US
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Telephone | 269-373-5360
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Fax | 269-373-5022
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DOUGLAS HOMNICK
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Credential | M.D.
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Telephone | 269-373-5261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number | 4301044487
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 4301044487
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License Number State | MI
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