Healthcare Provider Details

I. General information

NPI: 1194156638
Provider Name (Legal Business Name): HURON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 S VAN DYKE RD
BAD AXE MI
48413-9631
US

IV. Provider business mailing address

1060 S VAN DYKE RD
BAD AXE MI
48413-9631
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-7606
  • Fax: 989-269-7933
Mailing address:
  • Phone: 989-269-7606
  • Fax: 989-269-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301089490
License Number StateMI

VIII. Authorized Official

Name: KEN BARANSKI
Title or Position: VP/CFO
Credential:
Phone: 989-803-7127