MEDICARE: COMMUNITY MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NR1301X	Rural Acute Care Hospital	160020	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00141	OTHER	MI	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083658140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 419
Second Line	:
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-0419
Country	:	US
Telephone Number	:	231-627-5601
Fax Number	:	231-627-1471

Provider Business Practice Location Address
First Line	:	748 S MAIN ST
Second Line	:
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-2220
Country	:	US
Telephone Number	:	231-627-5601
Fax Number	:	231-627-1471

Authorized Official
Title or Position	:	BOARD
Name	:	MS. SUSAN A ENO
Credential	:
Telephone Number	:	231-627-7111

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	09/15/2010

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Directions to “COMMUNITY MEMORIAL HOSPITAL ” Practice Location

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