Provider Demographics
NPI:1124448154
Name:INGHAM COUNTY MEDICAL CARE FACILITY
Entity type:Organization
Organization Name:INGHAM COUNTY MEDICAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:517-381-6199
Mailing Address - Street 1:3860 DOBIE RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3704
Mailing Address - Country:US
Mailing Address - Phone:517-381-6100
Mailing Address - Fax:517-381-6201
Practice Address - Street 1:3860 DOBIE RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3704
Practice Address - Country:US
Practice Address - Phone:517-381-6100
Practice Address - Fax:517-381-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
236869Medicare Oscar/Certification
MI2085007Medicaid