Provider Demographics
NPI:1023189511
Name:HARBOR ARTHRITIS CENTER, PC
Entity Type:Organization
Organization Name:HARBOR ARTHRITIS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUEBNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-487-2150
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:STE 560
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-2150
Mailing Address - Fax:231-487-6562
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:STE 560
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-2150
Practice Address - Fax:231-487-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110B410710OtherBCBSM
MI900002253OtherPRIORITY HEALTH
MI104086827Medicaid
MI660002791OtherRAILROAD MEDICARE
MI0N96470Medicare Oscar/Certification
MI1277420001Medicare NSC