1316383706 NPI number — HURLEY MEDICAL CENTER

Table of content: (NPI 1316383706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316383706 NPI number — HURLEY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HURLEY 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:
Provider Other Organization Name Type Code:
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:
1316383706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 ROBERT T LONGWAY BLVD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48503-2190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-262-2320
Provider Business Mailing Address Fax Number:
810-239-1281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 ROBERT T LONGWAY BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48503-2190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-262-2320
Provider Business Practice Location Address Fax Number:
810-239-1281
Provider Enumeration Date:
05/13/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STUCKY
Authorized Official First Name:
KIRK
Authorized Official Middle Name:
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
810-262-2320

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  6401009300 , 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)