Provider Demographics
NPI:1003002429
Name:HURLEY PHO OF MID - MICHIGAN
Entity Type:Organization
Organization Name:HURLEY PHO OF MID - MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:810-257-9653
Mailing Address - Street 1:701 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-1261
Mailing Address - Country:US
Mailing Address - Phone:810-257-9653
Mailing Address - Fax:
Practice Address - Street 1:701 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1261
Practice Address - Country:US
Practice Address - Phone:810-257-9653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HURLEY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty