Healthcare Provider Details

I. General information

NPI: 1548995566
Provider Name (Legal Business Name): MICHAEL ALLEN HURST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W MAIN ST STE 107
LANCASTER OH
43130-3799
US

IV. Provider business mailing address

2745 BOVING RD SW
LANCASTER OH
43130-8939
US

V. Phone/Fax

Practice location:
  • Phone: 740-652-0955
  • Fax:
Mailing address:
  • Phone: 740-652-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: