PRIME HEALTHCARE SERVICES-PORT HURON LLC (NPI# 1912525361) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912525361 |
| Entity Type | Organization |
| Organization Name | PRIME HEALTHCARE SERVICES-PORT HURON LLC |
| Practice Address |
2601 Electric Ave Port Huron MI 48060-6587 |
| Practice Telephone | 8102161500 |
| Mailing Telephone | 8102161500 |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2020-07-13 |
| Authorized Official Name | CHRISTOPHER SCOTT FULKS (CFO) |
| Authorized Official Telephone | 8102161361 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Lake Huron Medical Center | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4190 24th Ave, Fort Gratiot, MI 480593882 | 8102161500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902407844 | Prime Healthcare Services-port Huron LLC | Radiology | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2020-11-06 |
| 1356723027 | Prime Healthcare Services-port Huron LLC | Rehabilitation Unit | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2015-06-18 |
| 1306227764 | Prime Healthcare Services-port Huron LLC | General Acute Care Hospital | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2015-06-11 |
| 1184657884 | Prime Healthcare Services-port Huron LLC | Pharmacy | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2006-07-08 |
| Street Address |
2601 ELECTRIC AVE |
| City | PORT HURON |
| State | MI |
| Zip Code | 48060-6587 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174505069 | H Mcdonald Md, PC | Pathology | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2005-11-16 |
| 1902407844 | Prime Healthcare Services-port Huron LLC | Radiology | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2020-11-06 |
| 1013525070 | Serene Anesthesiology Pllc | Anesthesiology | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2020-07-16 |
| 1306460787 | Kyle W Doyle | Nurse Anesthetist, Certified Registered | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2020-06-02 |
| 1184272817 | Blue Water Rad Onc, LLC | Radiology | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2019-08-27 |
| 1588121685 | Huron Pathology Associates Pllc | Pathology | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2019-02-25 |
| 1922571280 | Caillie Dianne Stephenson | Speech-Language Pathologist | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2019-01-09 |
| 1356812697 | Aaron T Misner | General Practice | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2018-12-16 |
| 1063987410 | Courtney Sherman | Occupational Therapist | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2018-10-11 |
| 1851875223 | Sohaib Tariq | Physician Assistant | 2601 Electric Ave, Port Huron, MI 48060 | 2018-09-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740897297 | Casey Edward Bicker | Behavior Technician | 3245 Keewahdin Rd; Fort Gratiot, Mi 48059, Port Huron, MI 48060 | 2020-09-29 |
| 1962032078 | Brianne Salchert | Peer Specialist | 1170 Michigan Rd., Port Huron, MI 48060 | 2020-01-17 |
| 1982123006 | Kenneth Shine Heuvelman | Counselor | 3522 Holland Park Ln, Port Huron, MI 48060 | 2017-09-11 |
| 1346767506 | Kelly Baker | Social Worker | 520 Superior St., Port Huron, MI 48060 | 2017-08-28 |
| 1326418609 | Jean Burleigh | Chore Provider | 614 Staton, Port Huron, MI 48060 | 2015-09-30 |
| 1205242161 | Lisa Gray | Counselor | 2885 W Rick Dr, Port Huron, MI 48060 | 2014-07-10 |
| 1861758880 | Aaron Overly | Surgery | 2609 Electric Ave Ste B&, Port Huron, MI 48060 | 2012-04-03 |
| 1942591508 | S Akram Ali | Surgery | 3270 Waldheim Dr, Port Huron, MI 48060 | 2011-04-29 |
| 1417258179 | Nicholas Alexander Tobianski | Physician Assistant | 3550 Pine Grove Avenue, Port Huron, MI 48060 | 2010-11-11 |
| 1598092769 | Blue Water Pharmacy LLC | Pharmacy | 1524 10th Street, Port Huron, MI 48060 | 2009-11-10 |
| Find all providers in zip 48060 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306460787 | Kyle W Doyle | Nurse Anesthetist, Certified Registered | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2020-06-02 |
| 1972076412 | Scott Daniel Fye | Nurse Anesthetist, Certified Registered | 1221 Pine Grove Ave, Port Huron, MI 48060-3511 | 2019-01-08 |
| 1063984615 | Patrina Lupo | Nurse Anesthetist, Certified Registered | 1221 Pine Grove Ave, Port Huron, MI 48060-3511 | 2018-12-20 |
| 1023536190 | Philip Ross Lepine | Nurse Anesthetist, Certified Registered | 1221 Pine Grove Ave, Port Huron, MI 48060-3511 | 2017-09-08 |
| 1790234011 | Jason Gerald Rewalt | Nurse Anesthetist, Certified Registered | 1221 Pine Grove Ave, Port Huron, MI 48060-3511 | 2016-09-27 |
| 1942673918 | Satoya Troncoso | Nurse Anesthetist, Certified Registered | 2601 Electric Ave, Port Huron, MI 48060 | 2015-11-12 |
| 1740686450 | Port Huron Mercy Family Care Inc | Nurse Anesthetist, Certified Registered | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2014-11-06 |
| 1093119265 | Carrie L Cook | Nurse Anesthetist, Certified Registered | 1221 Pine Grove Ave, Port Huron, MI 48060-3511 | 2014-10-17 |
| 1215353032 | Jillian Hennessy Aldanal | Nurse Anesthetist, Certified Registered | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2014-03-17 |
| 1427472349 | St Joseph Mercy Port Huron | Nurse Anesthetist, Certified Registered | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2014-02-12 |
| Find all providers in PORT HURON | ||||
| City | PORT HURON |
| Zip Code | 48060 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.