Provider Demographics
NPI:1558616086
Name:HURON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HURON MEMORIAL HOSPITAL
Other - Org Name:PORT AUSTIN PRIMARY CARE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-803-7127
Mailing Address - Street 1:1100 S VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9615
Mailing Address - Country:US
Mailing Address - Phone:989-269-9521
Mailing Address - Fax:989-269-5602
Practice Address - Street 1:24 E SPRING ST
Practice Address - Street 2:
Practice Address - City:PORT AUSTIN
Practice Address - State:MI
Practice Address - Zip Code:48467-6736
Practice Address - Country:US
Practice Address - Phone:989-738-5222
Practice Address - Fax:989-738-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health