Provider Demographics
NPI:1841252251
Name:HERRICK MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:HERRICK MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP REV CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-585-7576
Mailing Address - Street 1:500 E POTTAWATAMIE ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-2018
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?:Yes
Parent Organization LBN:HERRICK MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-03
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI06088OtherPARAMOUNT
MI1556080Medicaid
MI00085OtherBCBS
MI104806OtherPERFER/CARE CHOICES
MIH04405OtherMCARE
MI1556080Medicaid
MI104806OtherPERFER/CARE CHOICES