Provider Demographics
NPI:1699868703
Name:COUNTY OF CALHOUN
Entity type:Organization
Organization Name:COUNTY OF CALHOUN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOTTIE KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERSOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-969-6380
Mailing Address - Street 1:190 E MICHIGAN AVE STE A100
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-4019
Mailing Address - Country:US
Mailing Address - Phone:269-969-6376
Mailing Address - Fax:
Practice Address - Street 1:190 E MICHIGAN AVE STE A100
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-4019
Practice Address - Country:US
Practice Address - Phone:269-969-6376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010148251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4281572Medicaid