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General NPI Number Information
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NPI Number | 1447277496
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Entity Type | Organization
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Legal Business Name | HURON MEDICAL CENTER P.C.
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 1221 PINE GROVE AVE
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City | PORT HURON
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State | MI
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Zip | 48060-3511
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Country | US
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Telephone | 810-982-5200
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Fax | 810-982-9776
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Provider Business Mailing Address
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Address Line | 1231 PINE GROVE AVE SUITE 2F
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City | PORT HURON
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State | MI
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Zip | 48060-3500
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Country | US
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Telephone | 810-982-5200
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Fax | 810-982-9776
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Authorized Official
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Title or Position | OFFICE MANAGER/BILLER
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Name | MRS. THERESA LYNN STILES
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Credential |
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Telephone | 810-982-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 4301051703
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License Number State | MI
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