Healthcare Provider Details

I. General information

NPI: 1316668163
Provider Name (Legal Business Name): HURON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S VAN DYKE RD
BAD AXE MI
48413-9615
US

IV. Provider business mailing address

1100 S VAN DYKE RD
BAD AXE MI
48413-9615
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-9521
  • Fax: 989-269-5260
Mailing address:
  • Phone: 989-269-9521
  • Fax: 989-269-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE REMLEY
Title or Position: CFO
Credential:
Phone: 989-672-5075