1164795357 NPI number — HURLEY HEALTH SERVICES

Table of content: (NPI 1164795357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164795357 NPI number — HURLEY HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HURLEY HEALTH SERVICES
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:
6
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:
1164795357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1125 S LINDEN RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-4073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-262-2160
Provider Business Mailing Address Fax Number:
810-732-2232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1794 N LAPEER RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LAPEER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48446-7664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-245-1800
Provider Business Practice Location Address Fax Number:
810-969-4407
Provider Enumeration Date:
02/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BUTERAKOS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
810-262-2160

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0M32030 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OB50731 . This is a "BCBSM URGENT CARE GROUP PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OD40125 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 70-0-B5-1070-0 . This is a "BLUE CROSS BLUE SHIELD GROUP #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OM32030 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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