| Organization Name: | PRIME HEALTHCARE SERVICES-PORT HURON, LLC |
| NPI Number: | 1134586852 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTOPHER DOAN (CHIEF COMPLIANCE COUNSEL) |
| Mailing Address: | 4190 24th Ave Fort Gratiot |
| State: | MI US |
| Postal Code: | 480593882 |
| Phone Number: | 8109897700 |
| Fax Number: | |
| NPI Enumeration Date: | 01/26/2016 |
| NPI Last Update Date: | 01/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 746818 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |