Healthcare Provider Details

I. General information

NPI: 1417900622
Provider Name (Legal Business Name): HERRICK MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E CUMMINS ST
TECUMSEH MI
49286-2074
US

IV. Provider business mailing address

PO BOX 548
ADRIAN MI
49221
US

V. Phone/Fax

Practice location:
  • Phone: 517-423-3887
  • Fax:
Mailing address:
  • Phone: 517-265-0229
  • Fax: 517-265-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN P SOMERS
Title or Position: PHYSICIAN BILLING SUPERVISOR
Credential:
Phone: 517-265-0333