Provider Demographics
NPI:1326070145
Name:HURON FAMILY PRACTICE CENTER PC
Entity Type:Organization
Organization Name:HURON FAMILY PRACTICE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:RUTHVEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:810-987-6200
Mailing Address - Street 1:1225 10TH ST
Mailing Address - Street 2:HURON FAMILY PRACTICE CENTER
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5205
Mailing Address - Country:US
Mailing Address - Phone:810-987-6200
Mailing Address - Fax:810-987-8717
Practice Address - Street 1:1225 10TH ST
Practice Address - Street 2:HURON FAMILY PRACTICE CENTER PC
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5205
Practice Address - Country:US
Practice Address - Phone:810-987-6200
Practice Address - Fax:810-987-8717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G44570Medicare ID - Type Unspecified