Provider Demographics
NPI:1427082510
Name:SANILAC COUNTY
Entity type:Organization
Organization Name:SANILAC COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-648-4098
Mailing Address - Street 1:171 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1062
Mailing Address - Country:US
Mailing Address - Phone:810-648-4098
Mailing Address - Fax:810-648-2646
Practice Address - Street 1:171 DAWSON ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1062
Practice Address - Country:US
Practice Address - Phone:810-648-4098
Practice Address - Fax:810-648-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI600001322OtherRR MEDICARE
MI010G610090OtherBLUE CROSS BLUE SHIELD OF
MI010G610090OtherBLUE CARE NETWERK
MI=========Medicare UPIN
MI010G610090OtherBLUE CARE NETWERK