Provider Demographics
NPI:1194156638
Name:HURON MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:HURON MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-803-7127
Mailing Address - Street 1:1060 S VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9631
Mailing Address - Country:US
Mailing Address - Phone:989-269-7606
Mailing Address - Fax:989-269-7933
Practice Address - Street 1:1060 S VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9631
Practice Address - Country:US
Practice Address - Phone:989-269-7606
Practice Address - Fax:989-269-7933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089490208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1861685307OtherNPI