Provider Demographics
NPI:1053408948
Name:COUNTY OF ST CLAIR
Entity type:Organization
Organization Name:COUNTY OF ST CLAIR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NAJIBAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:REHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-987-5300
Mailing Address - Street 1:3415 28TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6931
Mailing Address - Country:US
Mailing Address - Phone:810-987-9396
Mailing Address - Fax:810-985-2150
Practice Address - Street 1:3415 28TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-987-9396
Practice Address - Fax:810-985-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010111801223D0001X
MIAM051181208D00000X
251K00000X, 261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1940850Medicaid
MI5100911Medicaid
MI1940879Medicaid
MI2777362Medicaid
MI4046170Medicaid
MI4579060Medicaid
MI5100902Medicaid
MI56565BOtherHEALTH ALLIANCE PLAN
MI1905931Medicaid
MI2776481Medicaid
MI4750831Medicaid
MI2878033Medicaid
MI5100949Medicaid
MI133579Medicaid
MI2896309Medicaid
MI2777362Medicaid
MI56565BOtherHEALTH ALLIANCE PLAN