1346260692 NPI number — MUNSON HEALTHCARE CHARLEVOIX HOSPITAL

Table of content: (NPI 1346260692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346260692 NPI number — MUNSON HEALTHCARE CHARLEVOIX HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346260692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14700 LAKE SHORE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLEVOIX
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49720-1939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-547-4024
Provider Business Mailing Address Fax Number:
231-547-8088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14700 LAKE SHORE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLEVOIX
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49720-1939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-547-4024
Provider Business Practice Location Address Fax Number:
231-547-8088
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KORTH-WHITE
Authorized Official First Name:
KIRSTEN
Authorized Official Middle Name:
BETHANY
Authorized Official Title or Position:
PRESIDENT/CEO EAST REGION
Authorized Official Telephone Number:
989-348-0720

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  150021 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1557598 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4286 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 00095 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1001019 . This is a "NORTHERN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5170308 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00095 . This is a "BLUE CROSS HOSP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 134141100 . This is a "COMP CARRIER US POSTAL SV" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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