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Organization
MCLAREN PORT HURON
Active
Organization
MCLAREN PORT HURON
Active
Other names
PORT HURON HOSPITAL PHYSICIAN GRP
Organization subpart
No
Provider details
NPI number
Authorized official
BRIDGET SHOLTIS (VP/CFO)
(810) 989-3749
Entity
Organization
Contact information
Practice address
1209 RICHARDSON ST, PORT HURON, MI 48060-3548
(810) 984-5156
Mailing address
1221 PINE GROVE AVE, PORT HURON, MI 48060-3511
(810) 984-5156
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
EB086434
MI
1041C0700X
Clinical Social Worker
Primary
AG643729
MI
1041C0700X
Clinical Social Worker
LK034456
MI
1041C0700X
Clinical Social Worker
RM088438
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7509106270
BCBS
MI
Enumeration date
11/02/2009
Last updated
07/30/2020
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