Organization
NES OF PORT HURON, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MOORE (CFO)
(415) 435-4591
Entity
Organization
Contact information
Practice address
2601 ELECTRIC AVE, PORT HURON, MI 48060-6587
(810) 985-1580
Mailing address
PO BOX 742488, ATLANTA, GA 30384-2488
(800) 377-8721
(304) 697-1155
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356585327
—
MI
01
—
500G400400
BCBS - NP GROUP
MI
01
—
700G400410
BCBS
MI
01
—
DP7173
RR MEDICARE
—
Enumeration date
04/22/2009
Last updated
05/02/2013
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