Provider Demographics
NPI:1538382650
Name:CHIPPEWA COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:CHIPPEWA COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SENKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-253-3103
Mailing Address - Street 1:508 ASHMUN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1976
Mailing Address - Country:US
Mailing Address - Phone:906-635-1568
Mailing Address - Fax:906-253-1466
Practice Address - Street 1:508 ASHMUN ST STE 120
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1976
Practice Address - Country:US
Practice Address - Phone:906-635-1568
Practice Address - Fax:906-253-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030101261QC1500X, 261QF0050X, 261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI390A710130OtherBLUE CROSS BLUE SHIELD
MI1493178Medicaid
MI1845762Medicaid
MI5100223Medicaid
MI5100223Medicaid
MI5100223Medicaid