=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467678789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HURLEY MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 04/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1125 S LINDEN RD STE 200
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48532-4073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-262-2320
-----------------------------------------------------
Fax | 810-239-1281
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 HURLEY PLZ
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48503-5902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-262-9255
-----------------------------------------------------
Fax | 810-262-7317
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | KIMBERLY ECKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 810-257-9952
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 250040
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------