Healthcare Provider Details

I. General information

NPI: 1356585327
Provider Name (Legal Business Name): NES OF PORT HURON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 ELECTRIC AVE
PORT HURON MI
48060-6587
US

IV. Provider business mailing address

PO BOX 742488
ATLANTA GA
30384-2488
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-1580
  • Fax:
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-697-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MOORE
Title or Position: CFO
Credential:
Phone: 415-435-4591