MEDICARE: JACKSON COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073032355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON COUNTY

Provider Business Mailing Address
First Line	:	1715 LANSING AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-2193
Country	:	US
Telephone Number	:	517-788-4420
Fax Number	:	517-788-4373

Provider Business Practice Location Address
First Line	:	1715 LANSING AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-2193
Country	:	US
Telephone Number	:	517-788-4420
Fax Number	:	517-788-4373

Authorized Official
Title or Position	:	MEDICAL OFFICER
Name	:	MR. RICHARD THOUNE
Credential	:
Telephone Number	:	517-768-1658

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	09/18/2017

Similar Medicare Providers

1780692400 — JACKSON COUNTY
Practice Location Address:

1715 LANSING AVE
JACKSON, MI
49202-2193

Practice Phone: 517-788-4420
Practice Fax: 517-788-4373

1114254299 — MRS. PATRICIA WELLS OCONNELL LMSW
Practice Location Address:

1715 LANSING AVE STE 672
JACKSON, MI
49202-2193

Practice Phone: 517-788-4364
Practice Fax: 517-780-4739

1588991756 — MRS. AMY LYNN JEHNZEN LMSW
Practice Location Address:

1715 LANSING AVE STE 672
JACKSON, MI
49202-2193

Practice Phone: 517-788-4364
Practice Fax: 517-780-4739

1730697756 — AMY SCHULTZ MD, MPH
Practice Location Address:

1715 LANSING AVE STE 221
JACKSON, MI
49202-2193

Practice Phone: 517-788-4420
Practice Fax:

1801386768 — ANDREA MELISSA AGUILAR CORRALES M.S
Practice Location Address:

1715 LANSING AVE STE 257
JACKSON, MI
49202-2193

Practice Phone: 517-788-4292
Practice Fax:

1053275925 — SARAH WALTERS
Practice Location Address:

1200 N WEST AVE
JACKSON, MI
49202-2179

Practice Phone: 517-789-1200
Practice Fax:

Directions to “JACKSON COUNTY ” Practice Location

Language	Start Address	Practice Location

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