Provider Demographics
NPI:1417900622
Name:HERRICK MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:HERRICK MEMORIAL HOSPITAL INC
Other - Org Name:HERRICK MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN BILLING SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SOMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-265-0333
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221
Mailing Address - Country:US
Mailing Address - Phone:517-265-0229
Mailing Address - Fax:517-265-0829
Practice Address - Street 1:502 E CUMMINS ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-2074
Practice Address - Country:US
Practice Address - Phone:517-423-3887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI03860OtherPARAMOUNT PROVIDER NUMBER
MI7509109680OtherBCBS OPC NUMBER
MI7509109680OtherBCBS OPC NUMBER