Provider Demographics
NPI:1447277496
Name:HURON MEDICAL CENTER P.C.
Entity type:Organization
Organization Name:HURON MEDICAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-982-5200
Mailing Address - Street 1:1231 PINE GROVE AVE
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3500
Mailing Address - Country:US
Mailing Address - Phone:810-982-5200
Mailing Address - Fax:810-982-9776
Practice Address - Street 1:1221 PINE GROVE AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3511
Practice Address - Country:US
Practice Address - Phone:810-982-5200
Practice Address - Fax:810-982-9776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051703207RH0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110G41039OtherBCBSM HANNA
MI4397059Medicaid
MIP78652OtherBCN ALSAWAH
MIP115104OtherBCN HANNA
MI3165470Medicaid
MIP115104OtherBCN HANNA
MI0N52480Medicare PIN
MI110G41039OtherBCBSM HANNA
MI4397059Medicaid
MI0N52480002Medicare PIN