Healthcare Provider Details

I. General information

NPI: 1104889500
Provider Name (Legal Business Name): HERRICK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E POTTAWATAMIE ST
TECUMSEH MI
49286-2018
US

IV. Provider business mailing address

500 E POTTAWATAMIE ST
TECUMSEH MI
49286-2018
US

V. Phone/Fax

Practice location:
  • Phone: 517-424-3000
  • Fax:
Mailing address:
  • Phone: 517-424-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: TIM JAKACKI
Title or Position: PRESIDENT
Credential:
Phone: 517-265-0900