Healthcare Provider Details

I. General information

NPI: 1740686450
Provider Name (Legal Business Name): PORT HURON MERCY FAMILY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/14/2014
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 610669
PORT HURON MI
48061-0669
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-1868
  • Fax:
Mailing address:
  • Phone: 810-985-1868
  • Fax: 810-966-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: REBEKAH SMITH
Title or Position: PRESIDENT & CEO
Credential:
Phone: 810-985-1510