Provider Demographics
NPI:1679802896
Name:GENESEE COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:GENESEE COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-257-3155
Mailing Address - Street 1:G3373 S SAGINAW ST
Mailing Address - Street 2:BURTON HEALTH CENTER
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-1244
Mailing Address - Country:US
Mailing Address - Phone:810-237-4539
Mailing Address - Fax:810-742-2561
Practice Address - Street 1:G3373 S SAGINAW ST
Practice Address - Street 2:BURTON HEALTH CENTER
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-1244
Practice Address - Country:US
Practice Address - Phone:810-237-4539
Practice Address - Fax:810-742-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244015261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical