Healthcare Provider Details

I. General information

NPI: 1043441975
Provider Name (Legal Business Name): MYMICHIGAN MEDICAL CENTER ALPENA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12674 JEROME ST.
ATLANTA MI
49709
US

IV. Provider business mailing address

1501 W CHISHOLM ST
ALPENA MI
49707-1401
US

V. Phone/Fax

Practice location:
  • Phone: 989-785-5360
  • Fax: 989-785-5771
Mailing address:
  • Phone: 989-356-7285
  • Fax: 989-356-7305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES H SHERWIN
Title or Position: PRESIDENT
Credential:
Phone: 989-356-7245