1760742019 NPI number — HAMILTON COMMUNITY HEALTH NETWORK INC

Table of content: (NPI 1760742019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760742019 NPI number — HAMILTON COMMUNITY HEALTH NETWORK INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMILTON COMMUNITY HEALTH NETWORK INC
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:
HAMILTON BURTON PHARMACY
Provider Other Organization Name Type Code:
3
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:
1760742019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 E 5TH ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48502-1641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-406-4246
Provider Business Mailing Address Fax Number:
810-424-6029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
G3375 S SAGINAW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48529-1277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-406-4001
Provider Business Practice Location Address Fax Number:
810-237-6001
Provider Enumeration Date:
05/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
CLARENCE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
810-406-4951

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  5301009822 , 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: 2135377 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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