Provider Demographics
NPI:1982665642
Name:HERRICK MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:HERRICK MEMORIAL HOSPITAL, INC.
Other - Org Name:PROMEDICA HERRICK HOSPITAL
Other - Org Type:Doing Business As
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:PROMEDICA HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-31
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI383019015282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5170836Medicaid
MIH04405OtherMCARE
MI06088OtherPARAMOUNT
MI1556080Medicaid
MI104806OtherPREF AND CARE CHOICES
MI00085OtherBCBS
MI104806OtherPREF AND CARE CHOICES
MIH04405OtherMCARE