MEDICARE: INGHAM HEALTH PLAN CORPORATION

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1801623608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INGHAM HEALTH PLAN CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 30125
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48909-7625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 BELLE CHASE WAY STE 1
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48911-4201
Country	:	US
Telephone Number	:	517-336-3778
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LORI LYN NOYER
Credential	:
Telephone Number	:	517-336-3778

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	10/04/2024

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Directions to “INGHAM HEALTH PLAN CORPORATION ” Practice Location

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