MEDICARE: CHELSEA COMMUNITY 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	332B00000X	Durable Medical Equipment & Medical Supplies	0449850001	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	540H103220	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1457374514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHELSEA COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 457
Second Line	:
City	:	CHELSEA
State	:	MI
Zip	:	48118-0457
Country	:	US
Telephone Number	:	734-593-5910
Fax Number	:	734-593-5915

Provider Business Practice Location Address
First Line	:	14750 E OLD US HIGHWAY 12
Second Line	:
City	:	CHELSEA
State	:	MI
Zip	:	48118-1185
Country	:	US
Telephone Number	:	734-593-5910
Fax Number	:	734-593-5915

Authorized Official
Title or Position	:	CFO
Name	:	MICHAEL GUSHO
Credential	:
Telephone Number	:	734-858-6174

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	08/29/2016

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Directions to “CHELSEA COMMUNITY HOSPITAL ” Practice Location

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