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NPI Code Detail

MEDICARE: HERRICK MEMORIAL HOSPITAL INC

MEDICARE: HERRICK MEMORIAL HOSPITAL INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TB0200XCognitive & Behavioral Psychologist
21041C0700XClinical Social Worker
3101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
103860OTHERMIPARAMOUNT PROVIDER NUMBER
27509109680OTHERMIBCBS OPC NUMBER

General Provider Information

NPI Number : 1417900622
Entity Type Code : Organization
Provider Name (Legal Business Name) : HERRICK MEMORIAL HOSPITAL INC
Provider Business Mailing Address
First Line : PO BOX 548
Second Line :
City : ADRIAN
State : MI
Zip : 49221
Country : US
Telephone Number : 517-265-0229
Fax Number : 517-265-0829
Provider Business Practice Location Address
First Line : 502 E CUMMINS ST
Second Line :
City : TECUMSEH
State : MI
Zip : 49286-2074
Country : US
Telephone Number : 517-423-3887
Fax Number :
Authorized Official
Title or Position : PHYSICIAN BILLING SUPERVISOR
Name : MR. BRYAN P SOMERS
Credential :
Telephone Number : 517-265-0333
Provider Enumeration Date : 05/18/2006
Last Update Date : 06/21/2012

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