1033256011 NPI number — HERRICK MEDICAL CENTER

Table of content: (NPI 1033256011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033256011 NPI number — HERRICK MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERRICK MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HERRICK MEMORIAL HOSPITAL
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033256011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 E POTTAWATAMIE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TECUMSEH
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49286-2018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-424-3000
Provider Business Mailing Address Fax Number:
517-265-0496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 E POTTAWATAMIE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TECUMSEH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49286-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-424-3000
Provider Business Practice Location Address Fax Number:
517-265-0496
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JAKACKI
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
517-265-0900

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1556080 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5170836 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00085 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 06088 . This is a "PARAMOUNT" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: H04405 . This is a "M-CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104806 . This is a "PREFERRED CHOICE & CARE C" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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