Provider Demographics
NPI:1740609098
Name:HERRICK HOSPITAL
Entity Type:Organization
Organization Name:HERRICK HOSPITAL
Other - Org Name:HERRICK MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR, ACUTE CARE & PPCS REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-824-7576
Mailing Address - Street 1:PO BOX 635238
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5238
Mailing Address - Country:US
Mailing Address - Phone:517-424-3000
Mailing Address - Fax:517-265-0496
Practice Address - Street 1:500 E POTTAWATAMIE ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-2018
Practice Address - Country:US
Practice Address - Phone:517-424-3000
Practice Address - Fax:517-265-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23M334Medicare Oscar/Certification
MI23R334Medicare Oscar/Certification
MI231334Medicare Oscar/Certification