Healthcare Provider Details

I. General information

NPI: 1568775708
Provider Name (Legal Business Name): HERRICK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E KILBUCK ST
TECUMSEH MI
49286-2073
US

IV. Provider business mailing address

PO BOX 548
ADRIAN MI
49221-0548
US

V. Phone/Fax

Practice location:
  • Phone: 517-423-3887
  • Fax: 517-423-9433
Mailing address:
  • Phone: 517-265-0229
  • Fax: 517-265-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: BERNARD NAWROCKI
Title or Position: ADMIN DIRECTOR FINANCE
Credential:
Phone: 517-265-0390