Provider Demographics
NPI:1548995566
Name:HURST, MICHAEL ALLEN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:HURST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 BOVING RD SW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8939
Mailing Address - Country:US
Mailing Address - Phone:740-652-0955
Mailing Address - Fax:
Practice Address - Street 1:117 W MAIN ST
Practice Address - Street 2:STE 107
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3799
Practice Address - Country:US
Practice Address - Phone:740-652-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
251B00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management