Healthcare Provider Details

I. General information

NPI: 1205673241
Provider Name (Legal Business Name): MUNISING MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N7569 SPRUCE ST
AUTRAIN MI
49806
US

IV. Provider business mailing address

1500 SANDPOINT RD
MUNISING MI
49862-1406
US

V. Phone/Fax

Practice location:
  • Phone: 906-387-4338
  • Fax: 906-387-2825
Mailing address:
  • Phone: 906-387-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA GESHRICK
Title or Position: PATIENT BILLING REPRESENTATIVE
Credential:
Phone: 906-387-0639