=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740609098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERRICK HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2014
-----------------------------------------------------
Last Update Date | 04/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 E POTTAWATAMIE ST
-----------------------------------------------------
City | TECUMSEH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49286-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-424-3000
-----------------------------------------------------
Fax | 517-265-0496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 635238
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45263-5238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-424-3000
-----------------------------------------------------
Fax | 517-265-0496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, ACUTE CARE & PPCS REVENUE
-----------------------------------------------------
Name | HAYLEY STUDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-824-7576
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------