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	314000000X	Skilled Nursing Facility	163010	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15141	OTHER	MI	BLUE CROSS BLUE SHIELD
2	09718	OTHER	MI	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598793945
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	:	231-627-1242
Fax Number	:	231-627-1452

Provider Business Practice Location Address
First Line	:	748 S MAIN ST
Second Line	:
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-2220
Country	:	US
Telephone Number	:	231-627-1242
Fax Number	:	231-627-1452

Authorized Official
Title or Position	:	VICE PRESIDENT/FINANCE
Name	:	MR. TED P ANDERSON
Credential	:
Telephone Number	:	231-627-1203

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	05/29/2008

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Directions to “COMMUNITY MEMORIAL HOSPITAL ” Practice Location

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