Basic Information
| Provider Information | |||||||||
| NPI: | 1750714275 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HURLEY MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | HURLEY BRAIN FUNCTION ASSESSMENT CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 ROBERT T LONGWAY BLVD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485035993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102391975 | ||||||||
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| Practice Location | |||||||||
| Address1: | ONE HURLEY PLAZA | ||||||||
| Address2: | SON, 5TH FLOOR | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485035993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102629353 | ||||||||
| FaxNumber: | 8107600440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2013 | ||||||||
| LastUpdateDate: | 08/29/2013 | ||||||||
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| AuthorizedOfficialLastName: | SCHANG | ||||||||
| AuthorizedOfficialFirstName: | RUTH | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, PROF BILLING | ||||||||
| AuthorizedOfficialTelephone: | 8102629952 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.