Provider Demographics
NPI:1164795357
Name:HURLEY HEALTH SERVICES
Entity Type:Organization
Organization Name:HURLEY HEALTH SERVICES
Other - Org Name:HURLEY HEALTH SERVICES URGENT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTERAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-262-2160
Mailing Address - Street 1:1125 S LINDEN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4073
Mailing Address - Country:US
Mailing Address - Phone:810-262-2160
Mailing Address - Fax:810-732-2232
Practice Address - Street 1:1794 N LAPEER RD
Practice Address - Street 2:SUITE D
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-7664
Practice Address - Country:US
Practice Address - Phone:810-245-1800
Practice Address - Fax:810-969-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M32030OtherMEDICARE PTAN
MIOB50731OtherBCBSM URGENT CARE GROUP PIN
MIOD40125OtherBCBSM
MI70-0-B5-1070-0OtherBLUE CROSS BLUE SHIELD GROUP #
MIOM32030OtherMEDICARE GROUP #