NPIMap

Organization Active NPI

St Clair County Health Department

  • Family Nurse Practitioner
  • Port Huron, MI
National Provider Identifier
1932349396
Registry record updated Feb 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
TP173662 Issued in MI
Legal business name
ST CLAIR COUNTY HEALTH DEPARTMENT
Practice address
3415 28TH St
Port Huron, MI 48060-6931
Phone
(810) 987-9396
Fax
(810) 985-2150
NPI assigned
Feb 25, 2009
Last updated
Feb 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2009

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

Authorized official

Name
Mr. Jon B Parson, M.P.H.
Title
Director, Health Officer
Phone
(810) 987-9396

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X TP173662 MI Primary

Addresses

Primary practice location

3415 28TH St
Port Huron, MI 48060-6931

Mailing address

3415 28TH St
Port Huron, MI 48060-6931
Phone (810) 987-9396

Other identifiers 2

IdentifierTypeStateIssuer
700G460240OtherMIBLUE CROSS BLUE SHIELD OF MICHIGAN
1053408948MedicaidMI

National Provider Directory

National Provider Directory
Tax ID family
Mercy Hospital6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1235520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235520000000",
    "number": "1932349396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3415 28TH ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606931",
            "telephone_number": "810-987-9396",
            "fax_number": "810-985-2150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 28TH ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606931",
            "telephone_number": "810-987-9396",
            "fax_number": "810-985-2150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CLAIR COUNTY HEALTH DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-25",
        "last_updated": "2009-02-25",
        "status": "A",
        "authorized_official_last_name": "PARSON",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DIRECTOR, HEALTH OFFICER",
        "authorized_official_telephone_number": "810-987-9396",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.P.H."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "TP173662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MICHIGAN",
            "identifier": "700G460240",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053408948",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.