Healthcare Provider Details

I. General information

NPI: 1316383706
Provider Name (Legal Business Name): HURLEY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 ROBERT T LONGWAY BLVD SUITE 1
FLINT MI
48503-2190
US

IV. Provider business mailing address

2700 ROBERT T LONGWAY BLVD SUITE 1
FLINT MI
48503-2190
US

V. Phone/Fax

Practice location:
  • Phone: 810-262-2320
  • Fax: 810-239-1281
Mailing address:
  • Phone: 810-262-2320
  • Fax: 810-239-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6401009300
License Number StateMI

VIII. Authorized Official

Name: DR. KIRK STUCKY
Title or Position: THERAPIST
Credential:
Phone: 810-262-2320