NPIMap

Organization Active NPI

County of Grand Traverse

Doing business as Grand Traverse County Health Department

  • Public Health or Welfare Agency
  • Traverse City, MI
National Provider Identifier
1174670459
Registry record updated Sep 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
COUNTY OF GRAND TRAVERSE
Doing business as
Grand Traverse County Health Department
Practice address
2600 Lafranier Rd Ste a
Traverse City, MI 49686-4765
Phone
(231) 995-6111
Fax
(231) 995-6109
NPI assigned
Jan 5, 2007
Last updated
Sep 12, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
GRAND TRAVERSE COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 12, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Erin Carlson
Title
Accountant
Phone
(231) 995-6103

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X Primary
Clinic/Center 261Q00000X 4301028725 MI

Addresses

Primary practice location

2600 Lafranier Rd Ste a
Traverse City, MI 49686-4765

Mailing address

2600 Lafranier Rd Ste a
Traverse City, MI 49686-4765
Phone (231) 995-6111

Other identifiers 3

IdentifierTypeStateIssuer
772813923MedicaidMI
235100410MedicaidMI
773054097MedicaidMI

Other names 1

  • Grand Traverse County Health Department Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120210000778 MI Part B Supplier - Mass Immunization (Roster Biller Only) 7911176581 Practice locations: Traverse City, MI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
K-Town Youth Care

Locations

5376 N Long Lake Rd
Traverse City, MI 49685
Phone (231) 933-7519

2325 Garfield Rd N
Ste A
Traverse City, MI 49686

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Grand Traverse Medical CareTraverse City, MI, CCN 235088 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Jan 1, 1966
Jun 4, 1998

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473638400000",
    "number": "1174670459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 LAFRANIER RD STE A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496864765",
            "telephone_number": "231-995-6111",
            "fax_number": "231-995-6109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 LAFRANIER RD STE A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496864765",
            "telephone_number": "231-995-6111",
            "fax_number": "231-995-6109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF GRAND TRAVERSE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRAND TRAVERSE COUNTY",
        "enumeration_date": "2007-01-05",
        "last_updated": "2016-09-12",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "ACCOUNTANT",
        "authorized_official_telephone_number": "231-995-6103"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MI",
            "license": "4301028725",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "772813923",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "235100410",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "773054097",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Traverse County Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.