Provider Demographics
NPI:1558302497
Name:HURLEY HEALTH SERVICES
Entity Type:Organization
Organization Name:HURLEY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
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 1:4272 W VIENNA RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-9454
Practice Address - Country:US
Practice Address - Phone:810-687-2850
Practice Address - Fax:810-687-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M32030OtherMEDICARE PTAN
MI70-0-B5-1070-0OtherBCBS OF MICHIGAN GROUP #