| Allegiance Health | |
|
205 N East Ave Jackson MI 49201-1753 | |
| (517) 788-4800 | |
| Not Available |
| Full Name | Allegiance Health |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 205 N East Ave, Jackson, Michigan |
| Authorized Official Name and Position | Mark Smith (SVP - CMO, CEO HFAMG EXECUTIVE) |
| Authorized Official Contact | 5172056407 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Allegiance Health Po Box 67000 Department 272801 Detroit MI 48267-2728 Ph: (517) 841-6913 | Allegiance Health 205 N East Ave Jackson MI 49201-1753 Ph: (517) 788-4800 |
| NPI Number | 1073547964 |
|---|---|
| Provider Enumeration Date | 07/10/2006 |
| Last Update Date | 03/05/2024 |
| Certification Date | 03/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073547964 | NPI | - | NPPES |
| CC5829 | Other | MI | RR MEDICARE |
| 260C863890 | Other | MI | BCBSM |
| 680C810300 | Other | MI | BCBSM |
| 750910501/800C810270 | Other | MI | BCBSM LMSW/LLMSW |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (Michigan) | Secondary |
| 104100000X | Social Worker | (Michigan) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (Michigan) | Primary |
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